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The form and checklist collect applicant identity, household composition, contact details, demographic data, and housing information, plus required eligibility documentation such as state ID, Social Security information, utility bills, and proof of rent or mortgage. 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We would like to invite you to apply by returning the attached application via fax, [online www.caliheapapply.com](online www.caliheapapply.com), by mail or drop off in person.  \n[ ] Completed and signed intake form (CSD-43)  \n[ ] Review Energy Education, complete, sign and date CSD-321 Education Verification (Top section only)  \n[ ] Copy of valid state identification (Applicant only)  \n[ ] Copy of Social Security card (Applicant only)  \n[ ] Copy of ALL the pages of the current SoCal Gas bill  \n[ ] Copy of ALL the pages of the current SoCal Edison bill  \n[ ] Current rent receipt or contract, Section 8 / Housing certificate or mortgage statement (Must have current address)  \n[ ] CALFRESH recipient(s) must provide a copy ofEBT card or current NOTICE OF ACTION indicating benefit amount.  \n[ ] Income documentation for ALL ADULTS (18+) is required. Cal-Works recipient must provide a current Notice of Action or Memo from worker showing amounts received for the current month. SSI/SSA recipients must have a current award letter from Social Security Administration or the most recent bank statement showing the direct deposit of funds. Proof of Unemployment Benefit (EDD), Disability, Child Support, Retirement Pension, Alimony, etc.  \nIf you have questions, feel free to call 805-436-4021.  \nService Hours: MTWF 8AM-12PM, 1PM-4PM (Closed 12PM-1PM DAILY; Thursdays WEEKLY)  \nSHUT-OFF CLIENTS MUST HAVE “COMPLETE APPLICATION”IN THE OFFICE BY 3:00PM FOR SAME DAY PROCESSING  \nIncomplete applications will be denied 30 days from the date of the application  \nThis page is intentionally left blank  \n621 Richmond Ave. Oxnard CA 93030 Phone: (805) 436-4000  \nFax: (805) 204-4887  \n[www.ca-vc.org](www.ca-vc.org)  \nWX  \nHEAP  \n1. Name  _  2. Social Security Number   -  -  3. Date    \n4. Address  ___  City  ZIP   \n5. Date ofBirth  / /  6. Please indicate total number of people living in your house    \n7. Email  _  8.Telephone   -   -   \n9. Opt out of email and text list [ ]  \n| \u003Cbr>Applicant Demographic Worksheet |  |  |  |\n| --- | --- | --- | --- |\n| 1. Ethnicity | 4. Race | 5. Marital Status | 6. Family Type |\n| [ ] Hispanic/Latino | [ ] American Indian | [ ] Divorced | [ ] Multigenerational Household |\n| [ ] Not Hispanic/Latino | [ ] Asian | [ ] Domestic Partner | [ ] Nonrelated Adults w/children |\n|  | [ ] Multi-Racial | [ ] Married | [ ] Other |\n| 2. Gender\u003Cbr>[ ] Male [ ] Female\u003Cbr>[ ] Other\u003Cbr>[ ] Unknown Decline to State | [ ] Black/African American | [ ] Separated\u003Cbr>[ ] Single | [ ] Single Parent/Female\u003Cbr>[ ] Single Parent/Male |\n|  | [ ] Native Pacific Islander | [ ] Widowed | [ ] Single Person [ ] 2 or more adults |\n|  | [ ] Other\u003Cbr>[ ] Unspecified |  | No children\u003Cbr>[ ] 2 Parent Household |\n| 3. Disabled | [ ] White |  |  |\n| [ ] Yes [ ] No |  |  |  |\n| 7. Health Insurance | 8. Education | 9. Characteristic | 10. Housing |\n| [ ] None | [ ] 0-8th | [ ] Farmer | [ ] Rent |\n| [ ] Private | [ ] 9-12th | [ ] Migrant Farmer | [ ] Own |\n| [ ] VA\u003Cbr>[ ] Medi-Cal\u003Cbr>[ ] Medicaid\u003Cbr>[ ] Other | [ ] HS Grad/GED\u003Cbr>[ ] 12+\u003Cbr>[ ] College Grad | [ ] Seasonal Farmer\u003Cbr>[ ] Veteran Family [ ] Military Family | 11. Need Child Support Referral [ ] Yes [ ] No |\n| \u003Cbr>This Box is for Official use only |  |  |  |\n| Notes:   |  |  |  |\n\n_________________________________________________________________________________________  \n_________________________________________________________________________________________  \n\n| Program Year:   HP / FT [ ] Income: $ [ ] Household size:  [ ] Special needs\u003Cbr>[ ] Verify ID\u003Cbr>[ ] Verify SS Card [ ] Current Gas Bill [ ] Current Electric Bill | Bill of Choice: SCE / GAS / SUB\u003Cbr>[ ] Weekly [ ] Bi-Weekly [ ] Monthly [ ] None [ ] Copy of ","cbCainIiuRYD3Obw","https://ap.wps.com/l/cbCainIiuRYD3Obw","pdf",12418701,34,"English","# Required Application Materials\n# Applicant Information\n## Contact and Identity Details\n## Household and Address Information\n# Eligibility and Verification Checklist\n## Income and Benefit Documentation\n## Utility Bills and Housing Proof","[{\"question\":\"How can applicants submit the LIHEAP application?\",\"answer\":\"Applicants can return the attached application by fax, online (caliheapapply.com), by mail, or by dropping it off in person.\"},{\"question\":\"What documents are required for eligibility verification?\",\"answer\":\"Applicants must provide a completed and signed intake form, energy education verification, valid state identification, Social Security information, copies of the current SoCal Gas and SoCal Edison bills, and rent or mortgage documentation. Income documentation is required for all adults 18+.\"},{\"question\":\"What happens if the application is incomplete?\",\"answer\":\"Incomplete applications will be denied 30 days from the date of the application. Shut-off clients must have a complete application in the office by 3:00PM for same-day processing.\"}]","LIHEAP Application - Home Energy Assistance Program (HEAP/WX) | PDF",1789835079]