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LOW INCOME ENERGY ASSISTANCE PROGRAM …

LOW INCOME ENERGY ASSISTANCE PROGRAM APPLICATION County Department of Social Services How to apply for Low INCOME ENERGY ASSISTANCE PROGRAM (LIEAP) Fill out the application below and send it to the local department of social services in the county you live. Applications can be mailed, faxed or dropped off in person. The agency will review your application and either: Send you a form requesting information needed to complete your application or Send you a letter by mail that tells if you qualify for the PROGRAM , and if so the amount you will receive. Eligibility is based on availability of funds, eligibility criteria, having resources at or below $2,250 and meeting the INCOME test. Additional information about this PROGRAM can be viewed at Contact your local department of social services or the NC EBT Call Center at 1-866-719-0141 if you have questions or need ASSISTANCE .

I give my authorization for my utility company to release information regarding energy usage and bill payment for the last twelve months to agencies associated under the LIEAP. I understand that utility companies who furnish information to LIEAP will not be held responsible for disclosed

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