Community Action Agency

Low Income Home Energy Assistance Program

Please return your completed LIHEAP application to a Service Center along with the following:

• The original and photo copy of energy bill
• Photo copy of Social Security Cards for all household members
• Photo copy of Applicants' identification (Driver's License, FL ID or Voter Registration Card)
• Photo copy of proof of income for every member of the household for the prior month
• Proof of Income: Consecutive pay stubs, weekly (4-pay stubs), bi-weekly (2-pay stubs) if paid monthly (1-pay stub) Letter from employer on company letterhead indicating gross income for the prior month or current income tax return
• Income Award Letter(s):
  • SSA., SSI, VA, Pension, Welfare/TANF
  • Child Support/Alimony
  • Self Employed Income or Financial Support from Friends or Relatives
• (Income Self Declaration Form provided at CAA Service Centers)
• Proof of Assistance:
  • Food Stamps
  • Weatherization Assistance Program
  • Community Services Block Grant Program

LIHEAP guidelines require household income to determine participants eligibility.

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

150% OF THE POVERTY INCOME GUIDELINES

EFFECTIVE APRIL 1, 2011

The above figures are based on the 2011 U. S. Department of Health and Human Services (HHS) poverty guidelines published in the Federal Register on January 20, 2011.

Service Centers WILL NOT provide photo copies of required documentation.