LIHEAP Forms and Publications

HSEA 1

LIHEAP Application Form

HSEA 1-S

LIHEAP Application Form (Spanish)

HSEA 4

Energy Assistance Affidavit

HSEA 4-S

Energy Assistance Affidavit (Spanish)

HSEA 6

Zero Income Statement

HSEA 6-S

Zero Income Statement (Spanish)

HSEA 18

How It Works and Who Can Apply

HSEA 18S

How It Works and Who Can Apply (Spanish)

HSEA 34

Vendor Agreement

HSEA 34U

Vendor Agreement (Utility)

PWEA 35

LIHEAP Computation Worksheet

HSEA 36

Landlord Statement

HSEA 36-S

Landlord Statement (Spanish)

PWEA 37

LIHEAP Program Refund

HSEA 40

DCED/DHS Crisis Interface Referral Form

PWEA 41

Low-Income Home Energy Assistance Program (LIHEAP) Electronic Funds Transfer Application Form

PWEA 51

Conservation Tips to Reduce Energy Usage

PWEA 51-S

Conservation Tips to Reduce Energy Usage (Spanish)

OIG 189

Overpayment Referral