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APPENDIX B Effective: April 1, 2026

FORMAT FOR LIHEAP APPLICANT RECORDS

Required Documentation for Heating/Cooling Eligible Applicants  LIHEAP application signed by both the applicant and an agency representative.  Documentation of Social Security Number Verification (See Section 3.6) o Applicant: Copy of the social security card. o All other Household Members: Copy of the social security card, unless they meet the exception. All cards and/or documents must be legible.  A government or state issued photo I.D. – Applicant and all Household Members. All copies must be legible.  Proof of income for all household members (as applicable)  Verification of Employment (if applicable)  Documentation to support Vulnerability (Responsibility)  Verification of Citizenship  Verification of Active Energy Account  Verification of Utility Allowance (if applicable)  Verification of Disability (if applicable)  Copy of the Notification of Eligibility Letter

Required Documentation for Crisis Eligible Applicants  LIHEAP application signed by both the applicant and an agency representative.  Documentation of Social Security Number Verification (See above)  A government or state issued photo I.D. – Applicant and all Household Members. All copies must be legible.  Proof of income for all household members (as applicable)  Verification of Employment (if applicable)  Documentation to support Vulnerability (Responsibility).  Verification of Citizenship  Verification of Active Energy Account  Documentation such as a disconnect notice, or other documented information confirming there is an actual service interruption at the time of application  Documentation to support a claim of a Life Threatening situation, if needed  If the crisis is due to the need for a repair or replacement of A/C or furnace, the file must contain copies of the invoices to support purchase, installation, or repair of equipment  Completed LIHEAP Crisis Assistance Form  Copy of the Notification of Eligibility Letter