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410.

OTHER APPLICATION INFORMATION

The intake worker/interviewer must follow the questions on the rest of the application to collect demographic information on each household member.

411.

FUEL VENDOR INFORMATION

The applicant must list the primary and secondary energy vendor. The primary is the energy vendor that supplies the actual source of heat. The secondary is always the vendor that supplies electricity to the household. If electricity is the primary vendor, then electricity must also be recorded as the secondary vendor.

412.

APPLICANT CERTIFICATION

Applications must be signed and dated by the applicant who, in doing so, agrees to the following:  Applicant certifies that the information on the application is true and correct.  Applicant agrees to notify the sub grantee agency of any changes in the application within 10 days.  Applicant understands it is against the law to make false statements and such statements may result in prosecution.  Applicant authorizes the agency to refer the applicant to other services and programs within the state as deemed beneficial.  Applicant understands the right to a Fair Hearing if the applicant is dissatisfied with the application process or eligibility decision.  Applicant certifies that this is the only application submitted from or on behalf of the applicants’ household.  Applicant states that DEAP services have been explained and they are fully understood. The applicant’s signature and date along with the sub grantee interviewer’s signature and date attest to the validity of the application.

413.

ENERGY BURDEN DOCUMENTATION

To be eligible for energy assistance the household must show that they have an energy burden. Documentation of the need for a DEAP benefit begins with proof the applicant has an energy burden. A Vendor Declaration Form must be signed by the applicant (See Section 1800, Forms).