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Low Income Home Energy Assistance Program Division 10 Service 415 Program 415 Chapters 05 - 65 North Dakota Department of Health and Human Services

SFN 529, Application 415-65-05 SFN 530, Eligibility and Benefit Worksheet 415-65-10 SFN 530, Identification 415-65-10-05 SFN 530, Part I, Income Deductions 415-65-10-10 SFN 530, Part II, Income Received 415-65-10-15 SFN 530, Part III, Summary 415-65-10-20 SFN 530, Part IV, Heating Benefit Level 415-65-10-25 SFN 530, Part V, Authorization Dates 415-65-10-30 SFN 530, Part VI, Effective Date 415-65-10-35 SFN 530, Computerized Calculations 415-65-10-40 SFN 1540, Income Averaging/Annualizing Worksheet 415-65-15 SFN 1540, Annualizing Worksheet 415-65-15-05 SFN 1681, Near Zero Income Worksheet 415-65-20 SFN 11, Emergency Assistance Action Plan 415-65-25 SFN 62, Emergency Assistance Application/Assessment 415-65-30 SFN 1059, Authorization for Release of Information 415-65-40 Statewide Benefit Matrix Appendix 415-65-50 Case Management Inter-Agency Referral Form 415-65-55 Monthly Case Management Billing and Reporting Form 415-65-60