Page 66

DEO LIHEAP Policies and Procedures Manual Page 66

PART 4 – RESTORATION

YES NO QUESTION Was the home energy source restored as a result of the applicant receiving a LIHEAP benefit, either Home Energy or Crisis (alone or in combination with another program)? • If Yes, count the applicant as having home energy restored as a result of LIHEAP assistance • If No, do NOT count the applicant as having home energy restored as a result of LIHEAP assistance, however, the Applicant may still be eligible for services

Some additional questions to consider if assistance is needed in determining if the Applicant should be counted in this category YES NO QUESTION Is the applicant currently without any energy source, i.e., the utility has been disconnected or the tank is empty? Is the applicant using an alternative source for heating or cooling, i.e., they are using a fan because the HVAC unit is inoperable?

PART 5 - WAIVER

YES NO QUESTION Did the applicant sign the Authorization for Release of General and/or Confidential Information? • If Yes, maintain a copy of the Release in the client file. • If No, make sure to note; however, the Applicant CANNOT be denied services because of refusal to sign the waiver.

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Page 66

Official source

DEO LIHEAP Policies and Procedures Manual Page 66

PART 4 – RESTORATION

YES NO QUESTION Was the home energy source restored as a result of the applicant receiving a LIHEAP benefit, either Home Energy or Crisis (alone or in combination with another program)? • If Yes, count the applicant as having home energy restored as a result of LIHEAP assistance • If No, do NOT count the applicant as having home energy restored as a result of LIHEAP assistance, however, the Applicant may still be eligible for services

Some additional questions to consider if assistance is needed in determining if the Applicant should be counted in this category YES NO QUESTION Is the applicant currently without any energy source, i.e., the utility has been disconnected or the tank is empty? Is the applicant using an alternative source for heating or cooling, i.e., they are using a fan because the HVAC unit is inoperable?

PART 5 - WAIVER

YES NO QUESTION Did the applicant sign the Authorization for Release of General and/or Confidential Information? • If Yes, maintain a copy of the Release in the client file. • If No, make sure to note; however, the Applicant CANNOT be denied services because of refusal to sign the waiver.