Nevada Energy Assistance Form – Fill Out and Use This PDF

IMPORTANT NOTICE

How to Apply for the Energy Assistance Program (EAP)

Submit a completed application (to include the name, date of birth and Social Security Numbers for EVERY PERSON who lives in your home) with the following verification:

1.Proof of identity for the head of household (such as a driver’s license, government issued I.D., school I.D., etc.) and;

2.Proof of citizenship or legal status if born outside of the United States and;

3. Proof of where you live:

a.Provide a complete copy of your rental/lease agreement (listing all persons

in your home) and the signature page, or

b.a copy of your mortgage statement and;

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4.Provide a copy of most recent heating/cooling bills and;

5.When the utility bill is not in the applicant’s name, proof of identity for the individual listed on the utility bill is required along with written authorization for

the applicant to apply, that includes their address, phone number and signature

and;

6.Proof of ALL income for EVERY PERSON in the household for at least the last thirty (30) days.

Examples of types of income: Employment, child support, social security, Veterans benefits, retirement, public assistance, utility reimbursements, unemployment insurance, interest income, money from family and/or friends, or organizations, educational scholarships and/or grants, etc.

Note: If the employed individual is working through an employment agency, provide proof of the last 12 months of earned income.

7.If the household expenses exceed the household income, proof of how the household is meeting their needs.

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**FAILURE TO PROVIDE THIS INFORMATION MAY DELAY THE

PROCESSING OF YOUR APPLICATION. **

Prior year recipients may not reapply until approximately 11 months after they

received their last benefit.

Applications are processed in the order in which they are received. Applicants will receive a notice of decision once an eligibility determination has been made.

Please mail or fax your application and verifications to:

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Division of Welfare and Supportive Services

ENERGY ASSISTANCE APPLICATION

The Energy Assistance Program (EAP) is designed to help eligible Nevada households with their annual heating and electric costs.

 INCOME REQUIREMENTS 

The total gross monthly income of all household members may not exceed the amounts shown in the chart below.

YOUR HOUSEHOLD’S GROSS MONTHLY INCOME MAY NOT EXCEED:

(For families/households with more than 8 persons, add $6,810 for each additional person).

Households with a chronic or long-term illness, who pay out of pocket medical expenses and whose gross income exceeds the income guidelines, may have their countable income reduced by verified qualifying expenses.

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 BENEFITS 

Eligible households receive an annual one-time per year benefit called a “fixed annual credit” customarily paid directly to their energy provider(s). The benefit shows as a

credit on the bill.

MINIMUM PAYMENT –The minimum yearly payment for eligible households is $240.

 WHEN TO APPLY 

If your family is not currently on the program and you meet the income requirements, apply NOW.

If you received a benefit during the past 12 months, a notice will be mailed to you when it is time to reapply. If you submit an application prior to the date you’re eligible to reapply, the application will be denied.

 WHAT DO I NEED? 

Submit a completed an EAP application with the required documentation. Suggested income verifications are noted on the back of this page. To get answers to other questions, call:

Visit our website at: http://dwss.nv.gov for more information on the program requirements.

You can find information about the Weatherization Assistance Program at:

http://housing.nv.gov/programs/Weatherization/

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