Has your household received any income in the month before you applied for LIHEAP?
If yes: please tell us where it came from and how much you received.
Verification: Verification of any income received will be required.
Types of verification: proof of how much was given as a gift and when, receipts for items sold, or other documentation as needed.
Needs: please tell us how your household is meeting its needs for the following items: Food, Shelter, Utility Service.
| Question | Answer |
|---|---|
| Form Name | HSEA 6 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 22 |
| Avg. time to fill out | 4 min |
| Edition | 12/22 |
| Other names | HSEA 6, HSEA6, Zero Income Statement, LIHEAP zero income statement |
Zero Income Statement Apply Form isn’t the one you’re looking for?