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DEO LIHEAP Policies and Procedures Manual Page 46

D. Signed Notice Regarding Collection of Social Security Numbers E. Income amount and method of verification for all household members F. Income documentation to support eligibility G. Signed statement of self-declaration of income, if applicable H. Signed statement of how basic living expenses such as food, shelter, and transportation are being provided if the total household income is less than 50% of the current Federal Poverty Guidelines and no one in the household is receiving SNAP assistance I. Copies of Notices of Approval and Appeals or Notices of Denial and Appeals provided to the client J. Documentation of disability income or other verifiable documentation if preference or additional benefit provided due to a disability K. Documentation of client’s obligation to pay the energy bill for the residence in which client resides L. A signed LIHEAP application with the signatures of the applicant, subrecipient’s representative, and supervisory staff M. Notation on whether or not energy was connected, saved from disconnection, or repairs were made to heating/cooling units N. A signed Authorization for Release of General and/or Confidential Information. .03 Mandatory Verification – The following eligibility criteria must be verified: A. Identity of the applicant and Other Household Members: any document that establishes identity will be accepted. Documents include, but are not limited to: 1. Driver’s license (a.) Work or school ID (b.) ID card from health benefits or another assistance or social service program (c.) Voter registration card (d.) Birth certificate (e.) Family census card (f.) Other reasonable sources that contain a photo and are third party verifiable. B. Citizenship or Legal Permanent Resident Status for the applicant or Other Members of the Household: any document that establishes the residential status of anyone in the household will be accepted. Documents include, but are not limited to: