Page 33

DEO LIHEAP Policies and Procedures Manual Page 33

A. Full Name B. Street Address with Zip Code C. Date of Application D. Household Size E. Social Security Numbers of all household members F. Number of Disabled, elderly and children 5 years of age and under in the household G. Ages of children 5 and under in the household H. Utility Account Number I. Assistance Type: Home Energy (Heating or Cooling); Crisis (Heating or Cooling); Weather Related J. Benefit Amount K. Date Vendor was paid L. Intake/Case Worker M. Service Area Location N. Total Calculated Gross Annual Income and Poverty Level O. Whether the energy source was reconnected, saved from disconnection, or repairs provided all benefits .09 Methods of Payment A. The subrecipient should first attempt to make vendor payments in the name and account number of the applicant. B. Payments should be made directly to vendors, including landlords (preferably only those with valid vendor agreements with the subrecipient). 1. A two-party check is acceptable, naming the vendor first and the applicant second if a vendor payment is impossible or if it would delay the resolution of a home energy crisis. C. If the name on the utility account is different from the application, then an explanation must be entered into the client file. Subrecipient records must be enough to track all payments to the appropriate applicant. D. All LIHEAP payments are for the benefit of all members of the household.

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Page 33

Official source

DEO LIHEAP Policies and Procedures Manual Page 33

A. Full Name B. Street Address with Zip Code C. Date of Application D. Household Size E. Social Security Numbers of all household members F. Number of Disabled, elderly and children 5 years of age and under in the household G. Ages of children 5 and under in the household H. Utility Account Number I. Assistance Type: Home Energy (Heating or Cooling); Crisis (Heating or Cooling); Weather Related J. Benefit Amount K. Date Vendor was paid L. Intake/Case Worker M. Service Area Location N. Total Calculated Gross Annual Income and Poverty Level O. Whether the energy source was reconnected, saved from disconnection, or repairs provided all benefits .09 Methods of Payment A. The subrecipient should first attempt to make vendor payments in the name and account number of the applicant. B. Payments should be made directly to vendors, including landlords (preferably only those with valid vendor agreements with the subrecipient). 1. A two-party check is acceptable, naming the vendor first and the applicant second if a vendor payment is impossible or if it would delay the resolution of a home energy crisis. C. If the name on the utility account is different from the application, then an explanation must be entered into the client file. Subrecipient records must be enough to track all payments to the appropriate applicant. D. All LIHEAP payments are for the benefit of all members of the household.