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SEC LIHEAP MANUAL JANUARY 2022 79

1600 INSTRUCTIONS FOR COMPLETING A LIHEAP APPLICATION

REQUIREMENT A form 6000 application must be completed for all households applying for assistance in order to determine eligibility. BASIC CONSIDERATION Items detailed below must be completed by either entering data or checking a line on the form. Where data is entered, it must be printed in block letters, one letter per line, up to the maximum number of lines per item provided on the form. No items on the form may be left blank except as indicated in the detailed instructions.

AGENCY - enter the three-digit code number assigned to the agency. -All three digits must be entered (example: ACTION, Inc. is 303) SOCIAL SECURITY NUMBER - enter the applicant's nine-digit Social Security Number - Any letters following the Social Security number are to be added outside the lines.

3. County Code - enter the county code for the county in which this applicant lives. This code must be entered as three digits. (example, Bacon County is entered as 003.)

3a. Fund Source -enter appropriate Fund Source code used to pay the application • LIHEAP BENEFITS (01, 04, 06) • LIHEAP BENEFITS (02) • DONATED FUNDS BENEFITS (03) • HEAT FUNDS BENEFITS (09) • PSC CRISIS BENEFITS (05) • PSC COMBINED BENEFITS (10, 11, 12)

4. Name

- enter the Name of the applicant as first name, middle initial, last name, skipping a space between each name or initial. Example: JOHN H SMITH