Blank Nevada Energy Assistance PDF Template

IMPORTANT NOTICE

How to Apply for the Energy Assistance Program (EAP)

Submit a completed application (to include the name, date of birth and Social Security Numbers for EVERY PERSON who lives in your home) with the following verification:

1.Proof of identity for the head of household (such as a driver’s license, government issued I.D., school I.D., etc.) and;

2.Proof of citizenship or legal status if born outside of the United States and;

3. Proof of where you live:

a.Provide a complete copy of your rental/lease agreement (listing all persons

in your home) and the signature page, or

b.a copy of your mortgage statement and;

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4.Provide a copy of most recent heating/cooling bills and;

5.When the utility bill is not in the applicant’s name, proof of identity for the individual listed on the utility bill is required along with written authorization for

the applicant to apply, that includes their address, phone number and signature

and;

6.Proof of ALL income for EVERY PERSON in the household for at least the last thirty (30) days.

Examples of types of income: Employment, child support, social security, Veterans benefits, retirement, public assistance, utility reimbursements, unemployment insurance, interest income, money from family and/or friends, or organizations, educational scholarships and/or grants, etc.

Note: If the employed individual is working through an employment agency, provide proof of the last 12 months of earned income.

7.If the household expenses exceed the household income, proof of how the household is meeting their needs.

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**FAILURE TO PROVIDE THIS INFORMATION MAY DELAY THE

PROCESSING OF YOUR APPLICATION. **

Prior year recipients may not reapply until approximately 11 months after they

received their last benefit.

Applications are processed in the order in which they are received. Applicants will receive a notice of decision once an eligibility determination has been made.

Please mail or fax your application and verifications to:

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Division of Welfare and Supportive Services

ENERGY ASSISTANCE APPLICATION

The Energy Assistance Program (EAP) is designed to help eligible Nevada households with their annual heating and electric costs.

 INCOME REQUIREMENTS 

The total gross monthly income of all household members may not exceed the amounts shown in the chart below.

YOUR HOUSEHOLD’S GROSS MONTHLY INCOME MAY NOT EXCEED:

(For families/households with more than 8 persons, add $6,810 for each additional person).

Households with a chronic or long-term illness, who pay out of pocket medical expenses and whose gross income exceeds the income guidelines, may have their countable income reduced by verified qualifying expenses.

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 BENEFITS 

Eligible households receive an annual one-time per year benefit called a “fixed annual credit” customarily paid directly to their energy provider(s). The benefit shows as a

credit on the bill.

MINIMUM PAYMENT –The minimum yearly payment for eligible households is $240.

 WHEN TO APPLY 

If your family is not currently on the program and you meet the income requirements, apply NOW.

If you received a benefit during the past 12 months, a notice will be mailed to you when it is time to reapply. If you submit an application prior to the date you’re eligible to reapply, the application will be denied.

 WHAT DO I NEED? 

Submit a completed an EAP application with the required documentation. Suggested income verifications are noted on the back of this page. To get answers to other questions, call:

Visit our website at: http://dwss.nv.gov for more information on the program requirements.

You can find information about the Weatherization Assistance Program at:

http://housing.nv.gov/programs/Weatherization/

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DOCUMENTATION EXAMPLES OF REQUIRED PROOF OF INCOME

All documentation sent with your application can be either originals or photocopies. If you are unable to photocopy the originals, our office will copy the material and if requested, we will send it back after your case has been processed.

Earned Income: Includes income from employment, self-employment (see below), child care services, house cleaning, and any service for which you are paid. Provide copies of check stubs (if paid in cash, a statement from the person who paid you for a service) for at least the last thirty (30) consecutive days. If paid weekly – 4 check stubs; paid bi-weekly or semi-monthly – 2 check stubs. If you do not have check stubs, a signed and dated statement of letterhead from your employer stating your gross income for the last thirty

(30)days and how often your get paid, is acceptable. If working through an employment agency or on-call provide proof of the last 12 months of income.

Self-Employment/Non-Profit Business Income: May include profit and loss statements signed by the applicant detailing gross income and expenses (receipts must be provided for deductions) during the last 12 months, a copy of the sales tax statement showing gross net proceeds, financial statements, a loan application listing income and expenses for the last 12 months, or DWSS Form 2011 that includes receipts for allowable deductions. Allowable deductions include: cost of goods sold, supplies and materials, advertising, accounting and legal fees, wages paid to employees, office space rent/mortgage, telephone, utilities, transportation costs necessary to produce income, etc.

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Unearned Income: Includes income from Social Security Administration, Veterans Administration, pensions, disability, military service, unemployment, child support, alimony, interest, dividends, regular insurance or annuity payments. If you are receiving

Social Security, SSI, Veterans Benefits, pensions, disability income, military income or unemployment: provide copies of the benefit verification form or award letter for the current year showing any cost of living raises. If you are receiving child support/alimony income: provide a copy of divorce decree/separation/settlement agreement or dated letter from the person paying the support (to include name, address and phone number), or a copy of the last check/statement from the child support enforcement agency. If you are receiving interest income/dividends: provide 12 months of bank

account statements, certificates of deposit or other documentation that contains details and is signed by the financial institution, or a broker’s quarterly statement showing earnings.

Cash Contributions and/ or Recurring Gifts: If someone is helping you pay your

expenses or is giving you money: provide a signed statement from each person that includes their name, address, phone number, if the assistance will continue, and the amount provided to you during the last six months. Provide a signed and dated statement by the person providing the money indicating the amount of support, how often it is paid,

when the arrangement began, and whether it is paid directly to a vendor or in cash to you. The statement must include the contributor’s printed name, address(es), and phone

number(s).

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Student Income: Includes ALL scholarships and grants, e.g., Pell Grant, Federal Supplemental Educational Opportunity Grant (FSEOG), Veterans Administration

educational benefits. Please provide written confirmation of the amount of assistance, and the educational institution’s written confirmation of the cost for the prior two (2) semesters and summer school (if applicable) of the student’s tuition, fees, books and equipment. If

benefits are paid directly to the student, copies of the latest benefit checks or canceled checks or receipts for tuition, fees, books, and equipment are acceptable.

Public Assistance Income: Includes but is not limited to TANF, county general assistance, Clark County Social Services, or American Indian/Alaska Native General Assistance. Provide a written statement from the public agency with the amount paid during the last month, or a copy of the award letter or check.

PLEASE NOTE: 1099 and W-2 forms by themselves are not acceptable as proof

of income.

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DIVISION OF WELFARE AND SUPPORTIVE SERVICES

ENERGY ASSISTANCE PROGRAM

MAIL OR FAX OUR APPLICATION TO ONE OF THE OFFICES LISTED BELOW OR EMAIL YOUR APPLICATION TO: ENERGYASSISTANCE@DWSS.NV.GOV

APPLICATION FOR ASSISTANCE

Please complete every section and answer each question. Sign the application and the Rights and Obligations form. Failure to complete all sections and questions and/or sign the application and Rights and Obligations, OR provide the requested documentation noted on the application, will delay processing your application and may result in your application being denied.

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