Forms

• 2016 LIHEAP Detailed State Plan (.pdf)
  
  
• 2016 Contract - Specific and General Terms & Conditions (.pdf)
  
  
• 2017 LIHEAP Household Information Form; pg 1 (.pdf)
  
  
• 2017 LIHEAP Household Information Form; pg 2 (.pdf) 
  
  
• 2017 LIHEAP Spanish Household Information Form; pg 1 (.pdf)
  
  
• 2017 LIHEAP Spanish Household Information Form; pg 2 (.pdf)
  
  
• 2016 Two Advances/One Reimbursement Voucher Spreadsheet (.xls)
  
  
• 2017 Back-up Heat Cost (.pdf)

• 2017 Actual and Surrogate Heat Costs (.pdf)

• 2017 Roomer Boarder Heat Costs (.pdf)

• 2017 EAP Income Guidelines (.pdf)
  
  
• 2016 LIHEAP Constants and Adjusters (.pdf)
  
  
• 2016 PSE Constants and Adjusters (.pdf)
  
  
• 2016 LIHEAP Upload File Specifications (.pdf)
  
  
• 2016 PSE Upload File Specifications (.pdf)
  
  
• Exhibit 1.1.1 (A): Ten Day Notice (.pdf)
  
  
• Exhibit 1.1.1 (B): Household Income Information Form (.pdf)
  
  
• Exhibit 1.1.1 (C): Employer Earned Income Form (.pdf)
  
  
• Exhibit 1.1.1 (D): Declaration of No Income (.pdf)
  
  
• Exhibit 1.1.1 (E): Visual Documentation Form (.pdf)
  
  
• Exhibit 1.1.1 (F): OES/Owner Release Form (.pdf)
  
  
• Exhibit 1.1.1 (G): Client Self-Dec Income Form (.pdf)
  
  
• Exhibit 1.2.2 (A): 2016 Actual And Surrogate Heat Cost (.doc)
  
  
• Exhibit 1.2.2 (B): 2016 Back-Up Heat Cost (.doc)
  
  
• Exhibit 1.2.2 (C): 2016 Roomer And Boarder Heat Cost (.doc)
  
  
• Exhibit 1.3.1 (A): Self Employment Income Worksheet (.pdf)
  
  
• Exhibit 1.3.1 (A): Self Employment Income Worksheet (.xls)
  
  
• Exhibit 1.3.1 (B): Rental Property Income Worksheet (.pdf)
  
  
• Exhibit 1.3.1 (B): Rental Property Income Worksheet (.xls)
  
  
• Exhibit 1.4.1 (A): Example Invitation To Bid (.pdf)
  
  
• Exhibit 2.2.0 (A): Proof of Residence (.pdf)
  
  
• Exhibit 4.1.2 (A): Client Education Checklist (.pdf)
  
  
• Exhibit 4.1.2 (B): Family Guide To Energy Efficiency (.pdf)
  
  
• Exhibit 4.1.2 (C): Can We Help Template (.pdf)
  
  
• Exhibit 4.1.2 (D): Conservation Education Certificate (.pdf)
  
  
• Exhibit 4.1.2 (E): Conservation Education Follow-up Form (.pdf)
  
  
• Exhibit 4.8.0 (A): Fair Hearing Request Form (.pdf)
  
  
• DSHS BVS Non-Disclosure Form (.doc)
  
  
• Employment Security-Earnings Deduction Chart (.pdf)
  
  
• UCC1 Financing Statement Form (.pdf)
  
  
• SSA Verification Sheet (.pdf)

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