Page 344

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

SFN 530, Identification 415-65-10-05 (Revised 10/1/17 ML #3512) View Archives

1. Identification Information 2. New Application: Enter the month of application. Re-computation: Enter the month of re-computation.

This form is available through the Department of Human Services and may also be obtained electronically via E-Forms.