Complete Fillable packet - PY2026 - English 12.29.25 - Low Income Home Energy Assistance Program (LIHEAP)

Sep 19, 2026

Low Income Home Energy Assistance Program (LIHEAP) PY 2026 acknowledgment and energy intake materials for San Joaquin County residents. The packet states eligibility tied to gross household incomes at or below 60% of State Median Income, and requires attachments for current utility bills and household income documentation. Applicants must provide proof of U.S. citizenship or permanent resident status, complete weatherization steps when applicable, and sign to acknowledge energy conservation and home budgeting tips. Forms collect household demographics, contact information, address details, and income categories including TANF/CalWORKs, SSI/SSP, SSA/SSDI, wages, and other income.

LanguageEnglish

CategoryForms

FormatPDF

Pages22

Reading Time8 min

AccessFree to download

Application for Gas/Electric & Weatherization

LIHEAP Acknowledgment Form

Eligibility and Required Attachments

Energy Intake Form (CSD 43)

Household Information and Income

APPLICATION FOR: GAS/ ELECTRIC & WEATHERIZATION APLICACIÓN PARA: GAS/ ELECTRICIDAD & CLIMATIZACIÓN Clear Form Department of Aging and Community Services LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP) PY 2026 ACKNOWLEDGMENT FORM (CE-CSD 321) The San Joaquin County Low Income Home Energy Assistance Program (LIHEAP) can assist San Joaquin County residents with gross household incomes at or below 60% of State Median Income level. 2026 Income Guidelines at 60% of State Median Income (SMI) 1. Attach copies of all current energy bills for electric, gas, propane fuel, and wood. Please include all pages of each utility bill or invoice. FOR DELINQUENT/OR SHUT-OFF ACCOUNTS: Include the delinquent bill or notice in addition to the regular bill. 2. Attach copies of current income for everyone in the household. See the checklist on the back page of the application packet for acceptable documents and detailed instructions. 3. Attach a copy of the applicant’s proof of U.S. Citizenship or Permanent Resident Status (i.e. Birth Certificate, CA REAL ID, Certification of Naturalization, or Permanent Resident Card) . 4. FOR THE WEATHERIZATION PROGRAM: Please complete & return the San Joaquin County Weatherization Program Form with your completed LIHEAP application. 5. Please sign and date below to acknowledge you will review the Energy Conservation and Home Budgeting Tips upon receipt (to be sent separately) . To download the documents to your electronic device, please visit the website at: [www.sjchsa.org](www.sjchsa.org) and click on the Forms link. 6. Failure to provide all the required information may cause your application to be delayed or denied. Applicant’s Signature Date Applicant Name Email Address SAN JOAQUIN COUNTY ENERGY PROGRAM | PO BOX 201056 | STOCKTON, CA 95201 209-468-1500 􀀋 | Toll Free 1-844-428-2317 | 􀀋 209-932-2649􀀚 | [heap@sjgov.org](heap@sjgov.org) 􀀍| [www.sjchsa.org](www.sjchsa.org) | State of California
Department of Community Services and Development
Energy Intake Form
CSD 43 (05/2025) | | | | | | | | | | | | | | | | | Official Use Only: | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | | | | | | | | | | | | | | | | | | Priority Points | | | | | | | | | | | | | | | | | | | | | | A.C.C. | | | | | Agency: SJC Aging and Community Services Intake Initials: Intake Date: | | | | | | | | | | | | | | | | | Eligibility Cert Date | | | | | First name | | | | | | | Middle Initial | | | | | Last Name | | | | | | | Date of Birth | | | | | | | | | | | | | | | | | | | | | | MM/DD/YY | | | SERVICE ADDRESS – Address where you live (this cannot be a P.O. Box) | | | | | | | | | | | | | | | | | | | | | | Service Address | | | | | | | | | | | | | | | | | | | Unit Number | | | Service City | | | | | | | | Service County | | | | | | | | Service State | | | Service Zip Code | | | Have you lived at this residence during each of the past 12 months? ☐ Yes Is your service address the same as mailing address? ☐ Yes Do you own or rent your home? ☐ Own
☐ No
☐ No
☐ Rent | | | | | | | | | | | | | | | | | | | | | | Mailing Address | | | | | | | | | | | | | | | | | | | Unit Number | | | Mailing City | | | | | | | | Mailing County | | | | | | | | Mailing State | | | Mailing Zip Code | | | Social Security Number (SSN): | | | | | | | | | | | | | | | Home Phone ( ) | | | | | | | Mobile Phone ( ) Do you agree to opt in to receive text messages? ☐ Yes ☐ No | | | | | | | | | | | | | | | | | | | | | | E-mail Address: | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | PEOP

FAQs

Who is eligible to apply for LIHEAP in San Joaquin County for PY 2026?

The materials state that the program can assist residents with gross household incomes at or below 60% of State Median Income level.

What documents must be attached to the LIHEAP application?

Applicants must attach copies of current energy bills (including all pages), copies of current income for everyone in the household, and proof of U.S. citizenship or permanent resident status.

What information is collected in the Energy Intake Form (CSD 43)?

The form collects service and mailing addresses, contact details, household demographics, and income amounts by category, along with information for each household member.

Sep 19, 2026

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