EAP - Attach CC - EAP Completed Application Requirements~2.pdf

ATTACHMENT CC

COMPLETED APPLICATION REQUIREMENTS

The Contractor agrees to assist families applying for the Energy Assistance Program by ensuring the Application Packet is complete prior to submitting it to the Division of Social

Services (DSS). Contractor agrees to use the Intake Site Completed Application Checklist

(Attachment DD) and the Intake Site Log (Attachment EE) when submitting applications for compensation.

An application will only be considered complete, if all verifications applicable to the circumstances of the application are attached to the application. Failure to provide a completed application with all verifications will result in the agency not receiving reimbursement for the application received by EAP.

1. Energy Assistance Program Application (2824-EL)

Pages 1 through 5 have to be fully completed, with an answer for every question in sections A through G and initialed in sections H and I. The Head of Household needs to sign and date page 6 of the application (Section J. Signatures).

Some areas of special attention are:

• Energy Assistance Program Application (2824-EL) Page 1, Section A. It has to list the name, relationship, gender, date of birth, age, citizenship status, disability status, and social security number of everyone living under the same roof. The home address, mailing address and contact phone numbers have to be provided and current.

• Energy Assistance Program Application (2824-EL) Page 2, Section D. The utility information needs to be listed and complete. The name of the energy provider, the account number, as listed on a current bill, and the name on the account. Even if the client wants to have all of the money paid to the cooling vendor, the heating vendor needs to be listed. The arrearage question needs to be marked: Yes or No.

• Energy Assistance Program Application (2824-EL) Page 3-4, Section F. All income, regardless of source needs to be indicated on the application.

2. Verification of Identity

Verification of identity of the applicant will be required for all applications.

The following documents can be accepted as proof of identity:

• Driver’s license issued by the State or Territory either with a photograph of the individual or other identifying information of the individual such as name, age, sex, race, height, weight or eye color.

• Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska

Native tribal document if the document carries a photograph or other personal identifying information.

• Identification card issued by the Federal, State or local government with the same information included on driver’s licenses.

• School identification card with a photograph of the individual.

• U.S. military card or draft record.

• Military dependent’s identification card.

• U.S. Coast Guard Merchant Mariner card.

• Any combination of three or more corroborating documents to prove identity, such as marriage license, divorce decree, high school and college diploma, employer ID cards and property deeds and/or title.

3. Verification of Citizenship

The applicant must complete the application attesting all members requesting assistance are U.S. citizens, have legal immigration status, or are not citizens/without legal status. If the claim of citizenship or non-citizen status is questionable, further verifications must be secured to resolve the issue.

Copies of the following documents will, combined with acceptable proof of identity, establish a person’s U.S. citizenship or nationality for purposes of EAP benefits:

● United States passport;

● Report of birth abroad of a U.S. citizen (FS-240) issued by the Department of

State to U.S. citizens;

● Certificate of birth (FS-545) issued by a Foreign Service post or Certification of

Report of Birth (DS-1350) issued by the State Department;

● Certificate of Naturalization (N-550) or N-570) issued by the United States

Citizenship and Immigration Service (USCIS) through a court;

● Certificate of Citizenship (N-560 or N-561) issued by USCIS to persons who derive citizenship through a parent;

● United States Citizen Identification Card (I-197) issued by USCIS until 4/7/83 to citizens living near the Canadian or Mexican border who needed it for frequent border crossings (formerly I-179, last issued February 1974);

● Northern Mariana Identification Card issued by the USCIS to a collectively naturalized citizen born in the Northern Mariana Islands before November 3, 1986;

● Statement provided by the U.S. consular officer certifying the individual is a U.S.

citizen (this is given to a person born outside the U.S. who derives citizenship through a parent, but does not have a FS-240, FS-545 or DS-1350); or

● American Indian Card with a classification code “KIC” and a statement on the back identifying U.S. citizens of the Texas Band of Kickapoos living near the

U.S./Mexican border.

4. Residence

• If a client is buying their home, then a copy of a current mortgage statement will need to be provided.

• If the client is renting/leasing their residence, a copy of the lease listing all people living at that address, with the signature of both the tenant and the landlord will need to be provided. If the lease does not list all household members, a signed and dated statement from the landlord with a contact phone number, listing all persons living at the address is needed. Or a Rental Verification Form completed and signed by the landlord, listing their contact information is needed.

5. Utility Bills

Applications must be submitted by the person whose name appears on the utility bill or the applicant must provide written authorization, from the individual whose name is printed on the bill, to act on their behalf. The applicant must be the person who is responsible for paying the cost of energy for the household.

The following also needs to be provided:

• A current copy of heating and cooling utility bills.

• If the client does not receive service through Nevada Power, Southwest Gas, or

Sierra Pacific, then there needs to be 12 months of bills attached. The 12 month history has to be from the energy company or billing source and will need to reflect usage and dollar amount of each month.

6. Income (current income/financial means for ALL people living in the home)

• Earned income

Verifications for at least the most current 30 days of check stubs. If paid biweekly or semimonthly, at least the 2 most recent check stubs. If paid weekly, at least the

4 most recent check stubs. If started employment within last 30 days, then a letter from the company on their letterhead listing contact information, date of hire, employee name, rate of pay, schedule of pay (weekly, biweekly, semimonthly) and number of hours to be worked per week. If the client is self employed or works for a temporary or seasonal job, they will need to provide a 12-month history of earnings.

• Unearned income

Verifications for at least the most current 30 days proof of income, gifts and/or cash contributions. Social security recipients need to provide their current award letter. If a client is receiving monies paid directly to them or paid to one of their bills, a statement from the person paying the money is needed. The statement needs to include: the name and contact information for the person giving the money, specify who it is paid to (vendor or client), the amount, how long they have been paying, and if they plan to continue paying, the date the statement is written and a signature of the person writing the statement. If it is unemployment received from any state except the State of Nevada, an award letter and proof of the last 2 quarters earnings is needed. If it is child support paid from a state other than the State of Nevada, then a current court order or printout from the distributing state showing 12 months of payments is required.

Note: If basic living expenses (i.e. shelter, utility, etc.) exceed income provide verification of how the household is meeting current living expenses.

7. Complete Application Checklist

Attached to top of application packet, reflecting information included, Intake Site name and name of person certifying as completed packet of information unless income loss occurred within the last 60 days.

DSS agrees to provide compensation in the amount of $15 for each fully completed Application

Packet submitted. DSS will accept incomplete applications, but no compensation will be provided. DSS will provide a reason for each Application Packet that is considered incomplete.