Ldss 3421-2025

1. Click ‘Get Form’ to open the ldss 3421 application in our platform's editor.
2. Begin by filling out your personal information in Section 1, including your first name, last name, and current address. Ensure you print clearly and use blue or black ink.
3. In Section 2, indicate your housing situation by checking the appropriate box that describes your living arrangement. If applicable, provide details about your monthly rent or mortgage payment.
4. Proceed to Section 3 to provide heat and utility information. Answer whether you pay separately for heat and specify your main source of heating.
5. In Section 4, report all household income. List each member’s income as gross monthly amounts before deductions. Attach additional sheets if necessary.
6. Designate an authorized representative if needed in Section 5. Ensure you sign and date the application at the end before submitting it.

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