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Click ‘Get Form’ to open the ldss 4992 application in the editor.
Begin by filling out the 'Applicant Information' section. Enter your first name, middle initial, last name, and the last four digits of your Social Security Number (SSN). Provide your street address, apartment number (if applicable), city, state, zip code, and daytime phone number.
Next, move to the 'Household Information' section. List all individuals living in your household. For each person, include their name, SSN, date of birth, and indicate if they are blind or disabled by selecting 'YES' or 'NO'. If there are more than three members in your household, continue listing them on the reverse side of the form.
If applicable, answer whether anyone in your household has a medical condition worsened by extreme heat. If yes, ensure you have a note from a physician dated within the last twelve months.
Finally, read the certification statement carefully. Sign and date the application to affirm that all information provided is accurate.
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Home Energy Assistance Program (HEAP) Household SizeMonthly Income Household Size 1 person Monthly Income $3,322 Household Size 2 people Monthly Income $4,345 Household Size 3 people Monthly Income $5,367 Household Size 4 people Monthly Income $6,39010 more rows
How much can you make and still get heap?
Current federal LIHEAP income guidelines set household income maximums at no greater than 150% of the federal poverty guideline (FPG) OR no greater than 60% of a states median income (SMI). Income eligibility levels may not be set below 110% of the FPG.
How do you know if you qualify for a heap in NY?
You may be eligible for an Emergency HEAP benefit if: Your households available resources are: less than $2,500; or. less than $3,750 if any member of your household is age 60 or older, or under age 6.
Is there a second emergency HEAP in ny for 2025?
Tier I eligibility is based on gross income and household size, on the date of application the households gross income must be at or below 130% of federal poverty level for the household size; or at least one adult household member must be in receipt of ongoing assistance through Temporary Assistance (TA),
Is HEAP giving out air conditioners?
California. Year-round. LIHEAP operates on a calendar year and doesnt distinguish between heating and cooling. Services that meet heating and cooling needs are combined and available throughout the year.
cooling form pdf
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