Csd 43 form 2026

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The document is an Energy Intake Form from the Department of Community Services and Development, designed for individuals applying for assistance with energy costs through the Low-Income Home Energy Assistance Program (LIHEAP). It collects personal information, household demographics, income details, and utility service information to determine eligibility for energy assistance. The form requires applicants to provide consent for information sharing and outlines the process for appeals in case of denial.

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Click ‘Get Form’ to open the csd 43 form in the editor.
Begin by filling in your personal information, including your first name, last name, date of birth, and service address. Ensure that the service address is not a P.O. Box.
Indicate whether you have lived at your current residence for the past 12 months and if your mailing address is the same as your service address.
Provide details about the people living in your household and their income sources. Enter the total number of household members and their respective gross monthly incomes.
Select the energy bill you wish to apply for assistance and provide the utility company name along with your account number.
Complete any mandatory questions regarding energy sources used to heat your home and confirm if you are the account holder for any utility bills.
Finally, review all entered information for accuracy before signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (95 Votes)
2015	4.4 Satisfied (184 Votes)
2014	4.3 Satisfied (273 Votes)
2013	4 Satisfied (37 Votes)
2012	4 Satisfied (37 Votes)
2006	4.2 Satisfied (30 Votes)

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