EAP - Attach DD- Completed Application Checklist~1.pdf

This is an Energy Assistance Program Intake Site Application Checklist document issued by the State of Nevada, Department of Human Services, Division of Social Services under Governor Joe Lombardo's administration. The checklist serves as a standardized verification tool required to accompany completed EAP application packets submitted to the Energy Assistance Program. The document outlines mandatory documentation and verification requirements that intake sites must complete and attach to the top of applicant packages before forwarding them for processing.

The checklist requires intake site staff to verify completion of several key application components, including a fully completed EAP application form, applicant identification, citizenship verification for applicants born outside the United States, home or residence verification, heating and cooling utility bills or usage documentation, written authorization statements from utility bill account holders when the bill is not in the applicant's name, income verification, and any other relevant supporting documentation. The form includes designated signature lines for both intake site staff and EAP staff with accompanying date fields, along with a notes section for additional comments. The checklist is identified as form number 2886-EL, dated 12/25, and is designed to facilitate the administration of assistance for low-income and senior Nevada residents seeking support with home energy costs through the Low-Income Home Energy Assistance Program.