Emergency Home Energy Assistance for the Elderly Program (EHEAP) - Application

Sep 19, 2026

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Emergency Home Energy Assistance for the Elderly Program (EHEAP) provides heating and cooling (electric) bill support for eligible households with members age 60 and older. Payments are made to the energy vendor or landlord when utilities are included with rent, based on income and residency requirements. Crisis assistance is available when a verifiable home energy crisis exists and documented eligibility criteria are met, requiring completion of the full EHEAP application with all specified documentation and signatures.

LanguageEnglish

CategoryForms

FormatPDF

Pages10

Reading Time4 min

AccessFree to download

Applicant (Aged 60 and older) Information

Section Two: Additional Household Members Information

Section Three: Household Characteristics

Section Four: Heating and Cooling Information

Section Five: Energy Crisis Explanation and Client Attestation and Signature

Emergency Home Energy Assistance for the Elderly Program (EHEAP) Summary of Services for ages 60 and older The EHEAP program provides heating/cooling (Electric) bill assistance. Payment is made to the energy vendor or landlord (if utilities are included with the rent) on behalf of the eligible household that meets income and residency criteria. Home Energy Crisis Assistance is provided to an elder who is in immediate danger of losing home energy. Benefit payment amounts are determined based on a documented home energy crisis and eligibility guidelines: • Elder (60+) must be experiencing a verifiable home energy crisis (see below) . Note: Payments can be for PAST DUE amounts only. • Household income must be below 100% Max Income Value (MIV) • St Johns County Resident o Cannot be a resident of a group living facility or a home where cost of residency is subsidized through a program administered by the state; o Cannot be a student living in a dormitory • Complete the entire EHEAP Application and provide ALL required documentation: o Drivers’ License or State Issued ID (over 18); Birth Certificate or School ID (under 18) o Social Security Card (Note: must have actual card) o Bank Statement (Last 30 days) o Proof of all income (Note: Bank Statement cannot be used to verify income) o Past Due Energy Bill o Copy of lease to verify if a utility allowance is given Emergency Home Energy Assistance for the Elderly Program-Application | Section One: Applicant (Aged 60 and older) Information | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | | Name: (First, M, Last) | | ☐ EHEAP ☐ Heating Season ☐ Cooling Season | | | | | | | Date of birth: | Age: | SSN: | | | | Date Stamp | | | Service address: | | | City: | | | | | | Florida County: | Zip Code: | | Phone: | | | Intake worker’s name:
Phone: | | | Gender: ☐ Male ☐ Female | | Number of people in the household: | | | | | | | Marital Status: ☐ Married ☐ Partnered ☐ Single ☐ Separated ☐ Divorced ☐ Widowed | | | | | | | | | Race: ☐ White ☐ Black/African American ☐ Asian ☐ Native Hawaiian/Pacific Islander ☐ American Indian/Alaska Native ☐ Other | | | | | | | | | Ethnicity: ☐ Hispanic/Latino ☐ Other | | Primary Language: ☐ English ☐ Spanish ☐ Other | | | | | | | Does client have limited ability reading, writing, speaking, or understanding the English language? ☐ Yes ☐ No | | | | | | | | | Is the client a veteran? ☐ Yes ☐ No | | Was client referred to the local Veteran’s Affairs office? ☐ Yes ☐ No ☐ N/A | | | | | | | Applicant’s income type(s): | | | | Applicant’s monthly income amount: | | | | | Section Two: Additional Household Members Information | | | | | | | | | Name: | | Income type(s): | | | | | | | | Age: | SSN: | | | Monthly income amount: | | | | Name: | | Income type(s): | | | | | | | | Age: | SSN: | | | Monthly income amount: | | | | Name: | | Income type(s): | | | | | | | | Age: | SSN: | | | Monthly income amount: | | | | Name: | | Income type(s): | | | | | | | | Age: | SSN: | | | Monthly income amount: | | | | Section Three: Household Characteristics | | | | | | | | | Is there a child 5 years of age or younger in the household? ☐ Yes ☐ No
If Yes, select all that applies: ☐ 0-2 years old ☐ 3-5 years old | | | | | | | | | Is there an individual with a disability in the household? ☐ Yes ☐ No | | | | | | | | | Is the applicant a U.S. citizen or an alien lawfully admitted for permanent residence? ☐ Yes ☐ No | | | | | | | | | Is the applicant a homeowner? ☐ Yes ☐ No | | | | | | | | | Does applicant live in government subsidized housing, such as Section 8? ☐ Yes ☐ No
If yes, provide the complex name: If yes, does the household receive an energy subsidy? ☐ Yes ☐ No | | | | | | | | | Does applicant live in a student dormitory, adult family care home, or any kind of group l

FAQs

Who is eligible for EHEAP emergency home energy assistance?

EHEAP targets eligible households with an elder aged 60 or older who is experiencing a verifiable home energy crisis. The household income must be below 100% Max Income Value and the applicant must meet residency requirements for St Johns County.

Where are benefit payments sent for eligible households?

Benefit payments are made to the energy vendor. If utilities are included with the rent, payments may be made to the landlord on behalf of the eligible household.

What documentation is required to complete the EHEAP application?

The application requires identification documents (Drivers’ License or State Issued ID for those over 18, Birth Certificate or School ID for those under 18), a Social Security card, a bank statement for the last 30 days, proof of all income, a past due energy bill, and documentation supporting any utility allowance (such as a copy of the lease).

Sep 19, 2026

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