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HOME ENERGY ASSISTANCE PROGRAM APPLICATION

GROSS MONTHLY AMOUNT $ YES NO WAGES SUBMIT WAGE STUBS FOR THE PAST 4 WEEKS. Note: Gross Weekly amounts are multiplied by 4.333333 to calculate the monthly amount. Gross Bi-Weekly amounts are multiplied by 2.166666 to calculate the monthly amount. WEEKLY $ BI-WEEKLY $ MONTHLY $ SEMI-MONTHLY Employer

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