LIHEAP Application IMPORTANT INFORMATION

Dear applicant,

Welcome! You may qualify for energy bill assistance via California’s Low Income Home Energy Assistance Program (LIHEAP). LIHEAP helps with:

• Electricity, propane, fuel oil (kerosene), wood, or wood pellets
• Emergency payments (must provide proof of disconnection notice/letter)
• Emergency repair or replacement of a water heater, heater, or AC/evaporative cooler

Eligibility for LIHEAP is based on the household’s total monthly gross income and a priority point system. This system takes into consideration homes with high energy burdens, the elderly, people with disabilities and/or medical life-threatening conditions, and children ages 5 and under.

2024 Federal Income Guidelines

Protect Your Community

If you have any information about possible fraud, waste, or the misuse of LIHEAP funds, please help us eliminate it by reporting it to the Federal Trade Commission (FTC) on their website at www.reportfraud.ftc.gov.

2024 IMACA LIHEAP Application Checklist

Below is a checklist of all documents you must turn in with the application. PLEASE BE SURE TO UPLOAD ALL DOCUMENTS. We cannot process your application until it is complete with all supporting documents and information. All supporting documents and proof of income must be within 30 days of the date that your application is received.

Application Packet (all included in the application form on the next page)

1. Education & Information Acknowledgement (Energy Saving Tips and Budgeting Tips for your use)
2. Energy Intake Form
3. Certification of Income and Expenses – ONLY if you or another household adult (18+ years) report no income
4. Account Holder Authorization and Consent Form – ONLY if energy accounts are NOT in your (the applicant’s) name.

Supporting Documents

1. Entire electric AND propane bills (must show account holder’s name, address, have at least 22 billing days, and include the usage)
2. If your utilities are included in rent, please submit a statement with the address, account number, usage (KwH), and signature of landlord.
3. Disconnection notice (if applicable)
4. Passport to Services or Notice of Action (if anyone in the household is receiving CalFRESH/food stamps, Cash Aid, General Relief, etc.)

Proof of Income

• Gross Wages
• Self-Employment
• Jobs Paid in Cash
• TANF or Cash Aid
• Unemployment Stubs
• Child Support
• Social Security Pension or Annuities
• Tribal Per Caps

Processing your application can take several weeks. During this time, you must continue paying your bill. We strongly encourage you to ask your energy provider about options for lower rates and/or payment plans. Once your application is reviewed, you will receive a notification letter of the outcome.