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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 11, Emergency Assistance Action Plan 415-65-25 (Revised 12/1/03 ML #2895) View Archives

The "Emergency Assistance Action Plan" is a form which may be used to assist the emergency assistance applicant and county LIHEAP eligibility worker to address problems that contributed to an energy crisis. It is designed to be used in combination with financial assistance from the Emergency Assistance Program of either LIHEAP or Energy Share of North Dakota with those applicants who are capable of making changes to improve their economic situation.

The first section explains the purpose of the Emergency Assistance Program. Space is provided for the worker to explain what emergency assistance has been approved.

The worker is to CIRCLE either "LIHEAP" or "Energy Share" to indicate which agency is completing the form.

Problem Statement This section should be used to identify problems the worker and customer agree have contributed to the crisis. Examples might be lack of education/training for a higher paying job, lack of transportation for job search, problems with developing and following a budget, shelter costs are too high for income available, etc.

Action Plan This section is used to identify possible referrals or other actions the customer can take to begin resolving the problems identified. For example, someone whose shelter costs are too high might be referred for weatherization services or to Low Income Housing. Use the "Comments" block to explain any details about the Action Plan. For example, the plan might include an application for Low Income Housing, but if there is a long waiting list, a referral to weatherization services can be made for the current residence as well as a referral to the energy supplier to negotiate a