ECAP INTAKE FORM - US Virgin Islands DHS - dhs gov 2025

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The document is an application form for the Energy Crisis Assistance Program administered by the Department of Human Services in the United States Virgin Islands. It collects personal and household information, including income, employment details, and household members, to assess eligibility for energy assistance. The applicant must affirm the accuracy of the provided information and acknowledge potential repayment if false information is discovered.

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Click ‘Get Form’ to open the ECAP INTAKE FORM in our editor.
Begin by entering the date at the top of the form. This is essential for record-keeping.
Fill in your address, including last name, middle name, and first name. Ensure accuracy for correspondence.
Provide your home and mailing addresses, along with your Social Security Number for identification purposes.
Complete the employment section by listing your employer and contact numbers. This information helps verify your income.
Indicate your age and total number of household members to assess eligibility for assistance.
In the supplier information section, enter your account number and total household income. Attach a copy of check stubs if required.
List other household members along with their ages, incomes, and relationships to you for comprehensive assessment.
Finally, complete the declaration section by affirming that all provided information is accurate before submitting the form.

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