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HOW TO APPLY: The head of household or spouse should contact your local community action agency office.

AMOUNT OF PAYMENT: If funding is available, all payment amounts will be set by the local agency in accordance with the LIHEAP Manual.

METHOD OF PAYMENT: All payments will be made directly to participating vendor typically within thirty (30) days of application approval. Eligible households will be notified when a payment is made on their behalf.

CONFERENCE OR FAIR HEARING: If you are not satisfied with the local agency’s decision about your application, you can request a conference and/or a formal hearing. For a formal hearing, you must submit a written request to the local agency within 45 days from when you were informed of the decision on your application. The State Office in Montgomery will make the final decision on all hearings. You may be entitled to free legal services concerning your dissatisfaction about your case.

If you have an appointment and are age 60 or over and/or disabled, someone can go to the appointment on your behalf. Please complete the following:

Revised 2025

I give _________________________ permission to make application for the Energy Assistance Program for my household. I (or my spouse) am

_____ age 60 or over

_____ disabled

___________________________________

_________________________ (Signature of Head of Household or Spouse)

Date

___________________________________

_________________________ (Witness, if signed by mark)

Date