Page 363

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

1. Does this bring household current? Current costs that will not maintain or restore home energy services due to shut-offs occurring as a result of unpaid arrearages are not eligible. Ineligible Energy Costs 415-50- 05-30 2. Referred for Self Reliance? If the household is having difficulty making ends meet do they need help to reduce their monthly costs or do they need employment etc.? 3. Referred for Energy Share? Do they also need assistance with their non-heat costs? The referral should be sent to the nearest Community Action Agency. Electric Utilities 415-50-05-25 4. SFN 11 Completed? SFN 11, "Action Plan" completed? Check "yes" or "no". NOTE that completion of SFN 11 is mandatory if the worker is making any referrals or recommendations for action on the part of the household. If your assessment is that no action is needed or feasible at this time, check "no" and do not complete SFN 11. Although we would like to see all households independent, it is important to recognize which people have reached the highest level of independence possible for them. Likewise, there may be justifiable reasons the household cannot work on problem areas such as inaccessibility of services, mental or physical illness, etc. Note the reason an Action Plan is not appropriate at the time of the Emergency application. 5. List Other Agencies Referred To? What other agencies can they be referred to? If you are going to refer them to Self Reliance make some suggestions to Self Reliance about problem areas.

"ASSESSMENT"

Assessments are to be completed on the LIHEAP System under Emergency Assistance. There is a screen on the system where you can type your assessment.