LEAP Application IML-4 is a structured document issued by the Colorado Department of Human Services for the Low-Income Energy Assistance Program (LEAP). This four-page application requires comprehensive personal and household information, including names, social security numbers, birth dates, income details, and residency status. Applicants must disclose their income sources, such as employment and other means like social security or public assistance, and provide proof such as pay stubs or award letters. The form also inquires about heating costs and housing situation, asking if the applicant’s heat is included in the rent or paid directly to a utility company. The application is designed to evaluate eligibility for heating cost assistance during the colder months.
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Follow our step-by-step instructions to fill out your LEAP application form:
First up, you shall skip the box “For County Use Only” and start by filling in the applicant’s personal information. Enter your full name, physical and mailing address (if they do not match), daytime phone number, date and place of birth, age, sex, citizenship, E-mail address, county of residence, and Social Security Number (SSN).
If you are applying for another person, make sure to enter this person’s data.
List other members that you share the household with. You must indicate their names, SSN, date, and place of birth, age, sex, and relationship to the applicant. Fill out an additional income questionnaire on the right-hand side.
If you have roommates, tenants, or other family members that are not part of your household, you may list them in this section. Please indicate their quantity, names, age, and relationship to you (or the applicant).
This section is the most complicated one. Here goes any specific factual information about your household’s gross monthly income. Keep in mind that it is a deciding factor in determining your LEAP eligibility. Describe who in your home has a full-time job, who is self-employed, and who has no work but receives some kind of non-work income. Enter the payment amount, the recipient’s info, the employer’s name (if any), and the payment frequency.
Indicate if you borrowed money, get a loan, or gift money to pay your housing costs last month. Distribute your real expenses between food, rent (if applicable), utilities, and other categories.
Indicate the type of your dwelling unit by checking the respective box. Determine if you rent the place or have an active mortgage payment. Do not forget to mention the monthly payment amounts (if applicable).
There are various programs of subsidized housing in the US. Please indicate if you are part of any of them (including Section 8, under the US federal Housing Act of 1937).
You will need to answer some more questions about your fuel type and heating equipment. Check the corresponding boxes carefully and fill out the missing information. Here, you will have to provide your fuel vendor’s data as well. If you are renting your place, ask your landlord about the heating facilities.
Please double-check the submitted data and make sure it is accurate.
The state law requires that all applicants provide proof of their lawful presence in the country. Therefore, you should submit readable copies of all documents listed in Section 8 of this form. Please make sure that all your documents are valid, fill out the affidavit form, and put your signature and calendar date.
This section comprises a short questionnaire on your fellow household members. Here, you may choose the applicant’s race and indicate the disability of any household member (if applicable). Please note that none of the information provided in this section will affect the decision on your eligibility.
The providers encourage you to submit information on how you found out about them. Please choose the corresponding answer.
In this section, you should agree to disclose the customer’s personal data. Read the disclosure through and choose your heating fuel type (natural gas or electric).
Read the closing consent form at the bottom of your application. Then, put the current date and your signature. If someone had helped you with the application form, provide the helper’s signature, physical address, and contact phone number.
Please note that some categories of households are entitled to get additional help outside of the LEA program. If you’re seeking financial aid to cover your utility expenses, do not hesitate to call the corresponding hotline or check with the official Colorado Department of Human Services website to determine if you are currently eligible. You may find the Department’s contact information in the top left corner of the application form.
