LIHEAP Forms and Publications

The following forms and publications are used in the LIHEAP Program:

Form or Publication Number

Form or Publication Name

PWEA 1

LIHEAP Application Form

PWEA 1-S

LIHEAP Application Form (Spanish)

PWEA 4

Energy Assistance Affidavit

PWEA 4-S

Energy Assistance Affidavit (Spanish)

PWEA 6

Zero Income Statement

PWEA 6-S

Zero Income Statement (Spanish)

PWEA 18

How It Works and Who Can Apply

PWEA 18S

How It Works and Who Can Apply (Spanish)

PWEA 32

Request for Additional Information

PWEA 32-S

Request for Additional Information (Spanish)

PWEA 34

Vendor Agreement

PWEA 35

LIHEAP Computation Worksheet

PWEA 36

Landlord Statement

PWEA 36-S

Landlord Statement (Spanish)

PWEA 37

LIHEAP Program Refund

PWEA 40

DCED/DPW 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)

PWEA 99

LIHEAP Information Needed for Supplies

OIG 189

Overpayment Referral

 

Reissued December 17, 2012, replacing December 14, 2012