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.
| 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.