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VIRGINIA DEPARTMENT OF SOCIAL SERVICES ENERGY ASSISTANCE

06/11 VOLUME IX, CHAPTER D, APPENDIX F, PAGE 1

PAYMENT NOTICE

XXXXXXXXXX XXXXXXXXXXXX XXXXXXXXXXXX XXXXXXXXX, XX 12345

XXXXXXXXXX XXXXXXXXXXXXXX XXX XXXXXXXXXXX XXXXXXXXXX, XX 54321

COMMONWEALTH OF VIRGINIA ENERGY ASSISTANCE PROGRAM

Date: Worker #: Phone #: Case #: City/County:

XX-XX Notice of Payments Made

The Energy Assistance Program made the following payments during the last heating or cooling season for your household. Any unused portion of your benefits is no longer available for payment.

TYPE PAID TO DATE AMOUNT

If the payments listed are incorrect, notify your Local Department of Social Services.

Applications are accepted for Fuel Assistance between the 2nd Tuesday in October and the 2nd Friday in November; for Crisis Assistance between November 1st and March 15th; and for Cooling Assistance between June 15th and August 15th.

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