Page 57

SECTION 1100 APPLICATION PROCESSING

LIHEAP MANUAL JANUARY 2022 57

1100.14 INELIGIBLE HOUSEHOLDS

• Households that reside in subsidized housing and the rent includes utilities; and the household cannot verify an energy burden. • Households that reside in rental housing and the rent includes utilities with no separate bill for heating/cooling costs; and the household cannot verify an energy burden. • SSI recipients living in congregate care or domiciliary care facilities or foster care placements who receive SSI state supplements. • Applicants who live in other public or private institutions whose living costs are subsidized by state or local government, i.e., residents of vocational facilities whose living costs are subsidized, persons in nursing homes or medical institutions. • Applicants who live in group living facilities/quarters, i.e., rooming, and boarding houses, hotels, institutions, workers dormitories, communes, military barracks, college dormitories, missions, flophouses and shelters, monasteries, sorority or fraternity houses, inmate facilities, or other quarters. • Applicants where ALL household members are non-U.S. citizens. 1100.15 ELIGIBILITY FORMS

The following forms are used to complete a Heating assistance application: • Intake/ Appointment Log • Application form 6000 • Worksheet Form 6003 • Citizenship Affidavit • Verification Checklist Form 6009 • Declaration of Zero Income Statement Form 6021 • Authorization to Release of Information Form 6022 The following forms are used to complete a Cooling assistance application: • Intake/ Appointment Log • Application form 6000a (blue form) • Worksheet Farm 6003 • Citizenship Affidavit • Verification Checklist Form 6009 • Declaration of Zero Income Statement Form 6021 • Authorization to Release of Information Form 6022