To apply for the LIEAP program using the online application, please use the "click here to apply" button below.
Below you will find specific forms that you may have been asked to complete by the LIEAP office.
If so, please click ‘Download File’ to open a printable version of the form.
Complete the form and submit to the LIEAP office.
If so, please click ‘Download File’ to open a printable version of the form.
Complete the form and submit to the LIEAP office.
| 2020-2021 Print Application |
| Employer Statement |
| Work Registration Verification |
| Rental Verification |
| Self Declaration of Zero Income |
| Statement of Incapacity |
| Self Declaration of Permanently Parked Traditional Dwelling |
| Authorized Representative Release Form |
| Change of Address |
Questions? Call us at 1-800-246-4221 for help.