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Applicants must complete housing and heating source details, certify citizenship/qualified status, acknowledge penalties for false statements, and consent to verification and disclosure of information for program administration.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/liheap-application-for-assistance/324390/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/liheap-application-for-assistance/324390.png","ImageObject",300,407,{"name":42,"@type":43},"Guten tag","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-22","2026-09-21",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What types of LIHEAP assistance can applicants apply for?","Question",{"text":63,"@type":64},"Applicants can apply for regular assistance or crisis assistance by checking the appropriate option on the form.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What information and documentation are required to submit the application?",{"text":68,"@type":64},"The application requires required documentation and a signature on page 2, household members’ Social Security numbers, income details, and income documentation for the most recent 30 days for every person in the household.",{"name":70,"@type":61,"acceptedAnswer":71},"How is crisis assistance eligibility determined?",{"text":72,"@type":64},"Crisis assistance eligibility depends on circumstances such as utility disconnect or disconnection-related issues, eviction notice due to utility overage or unpaid rent, running out of fuel, heating/airunit problems, and additional qualifying household criteria; 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USE ADDITIONAL PAPER IF YOU NEED MORE SPACE |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| (Provide name & information for each HH member)\u003Cbr>LAST NAME | FIRST NAME | M. I. | RELATION\u003Cbr>TO\u003Cbr>APPLICANT | SOCIAL\u003Cbr>SECURITY\u003Cbr>NUMBER | DATE OF\u003Cbr>BIRTH | SEX | RACE | Ethnicity | Vet or\u003Cbr>Military | Receive\u003Cbr>Asst for\u003Cbr>Disability | INCOME | TYPE OF\u003Cbr>INCOME |\n|  |  |  |  |  |  |  |  |  | Y or N | Y or N | Y or N |  |\n|  |  |  |  |  |  |  |  |  | Y or N | Y or N | Y or N |  |\n|  |  |  |  |  |  |  |  |  | Y or N | Y or N | Y or N |  |\n|  |  |  |  |  |  |  |  |  | Y or N | Y or N | Y or N |  |\n|  |  |  |  |  |  |  |  |  | Y or N | Y or N | Y or N |  |\n| IF A HOUSEHOLD MEMBER IS DISABLED AND NOT RECEIVING SSI OR SSDI, A COMPLETED VERIFICATION OF DISABILITY FORM, SIGNED BY A MEDICAL PROFESSIONAL, IS REQUIRED. |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |\n| APPLYING FOR CRISIS ASSISTANCE? Let's see if you qualify\u003Cbr>Do you have a utility disconnect, past due, disconnected, or less than $50 on pre-pay, an eviction notice due to utility overage, unpaid rent, are running or are out of fuel, your heat/airunit is not working properly? (circle one) Y or N If Yes, documentation must be attached. In addition you must meet one of the following criteria: (Please check ALL that apply) Documentation is required for circumstances marked.\u003Cbr>_____\u003Cbr>_____\u003Cbr>_____\u003Cbr>_____\u003Cbr>_____\u003Cbr>A household member 60 years or older in the home\u003Cbr>A household member 5 years or younger in the home\u003Cbr>A household member who is disabled (either receiving disability income or a verification of disability form) A household member who is a veteran or active military\u003Cbr>A household member requiring life support equipment\u003Cbr>_____\u003Cbr>_____\u003Cbr>_____\u003Cbr>_____\u003Cbr>_____\u003Cbr>Household wage earner lost their job or died within the last 12 months\u003Cbr>Household wage earner left the home within the last 45 days\u003Cbr>Household wage earner experienced a loss of significant work hours in the past 30 days Non-functioning or mal-functioning HVAC system in the home\u003Cbr>Unanticipated medical or major household expense that exceeds 100% of your utility bill |  |  |  |  |  |  |  |  |  |  |  |  |\n\n􀁘􀁘􀁘 ASSISTANCE WILL BE DENIED DUE TO AN APPLICANT'S REFUSAL TO FURNISH ALL HOUSEHOLD MEMBERS' SOCIAL SECURITY NUMBERS AND VERIFICATION 􀁗􀁗􀁗  HOUSEHOLD TOTAL INCOME: List income information for applicant and all household members Wages are only listed for household members 18 or older   \nHOUSEHOLD TOTAL INCOME: List income information for applicant and all household members. Wages are only listed for household members 18 or older.  \n\n| HOUSEHOLD MEMBER NAME | SOURCE OF INCOME | MONTHLY INCOME | HOW OFTEN INCOME RECEIVED |\n| --- | --- | --- | --- |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n| INCOME DOCUMENTATION FOR THE MOST RECENT 30 DAYS MUST BE ATTACHED FOR EVERY PERSON IN THE HOUSEHOLD A VERIFICATION OF INCOME AND EXPENSES FORM IS REQUIRED IF THERE ARE ANY ADULT HOUSEHOLD MEMBERS CLAIMING ZERO INCOME |  |  |  |\n\nHOUSING: (Please check one)  \n􀉛 OWN  \n􀉛  \nRENT  \n􀉛  \nLIVE WITH OTHERS","cbCaigqr3SxiXpEZ","https://ap.wps.com/l/cbCaigqr3SxiXpEZ","pdf",462800,"English","# Application Overview\n## Assistance Type and Prior LIHEAP Receipt\n# Household Information\n## Disabled Household Member Verification\n## Crisis Assistance Eligibility\n# Household Total Income\n## Income Documentation Requirements\n# Housing and Heating Details\n## Utility Payment Information\n# Applicant Certification and Consent","[{\"question\":\"What types of LIHEAP assistance can applicants apply for?\",\"answer\":\"Applicants can apply for regular assistance or crisis assistance by checking the appropriate option on the form.\"},{\"question\":\"What information and documentation are required to submit the application?\",\"answer\":\"The application requires required documentation and a signature on page 2, household members’ Social Security numbers, income details, and income documentation for the most recent 30 days for every person in the household.\"},{\"question\":\"How is crisis assistance eligibility determined?\",\"answer\":\"Crisis assistance eligibility depends on circumstances such as utility disconnect or disconnection-related issues, eviction notice due to utility overage or unpaid rent, running out of fuel, heating/airunit problems, and additional qualifying household criteria; applicable documentation must be attached.\"}]","LIHEAP Application for Assistance | PDF",1789967792,13]