LIHEAP Application

WHERE AND WHEN TO APPLY

You must apply for assistance at the CDCAA office in the county in which you currently reside. Applications will be accepted in person at each office location as follows: Arkansas County: Monday – Thursday, 9am-3pm; Cleveland County: Monday – Thursday, 9am-3pm; Grant County: Tuesday and Thursday, 9am-3pm; Jefferson County: Monday-Thursday, 9am-3pm; and Lincoln County: Monday, Wednesday, and Friday, 9am-3pm. All CDCAA offices close for lunch from 11:30am-12noon daily.

If your work schedule interferes with your application, you may call your local county office and request an appointment be set outside of the regular application hours OR you may submit your completed application and all required documentation by email to liheap@cdcaa.org OR you may send someone with all needed documents and a signed letter giving your permission for that person to apply on your behalf.

APPLICATION

LiHEAP applications are worked in the order in which they are received. It is the goal of CDCAA to work all applications within the time frame set forth by policy. Applicants will receive a Notice of Action informing them of the status of their application. Please note: multiple calls to Agency offices to check on the status of your application will delay the processing of all applications.

WHAT TO BRING – REQUIRED DOCUMENTATION

• Proof of income for yourself and for anyone 18 or older in the household for the month prior to date of application
• Proof of Social Security, SSI, Retirement, VA Benefits, if received
• Proof of unemployment benefits if no longer working for 6 months to a year before date of application
• Most recent utility bill(s)
• For Crisis Assistance, you must bring a shut-off notice
• Picture ID and social security cards for yourself and any 18 or older in the household
• If additional information is needed, you will have 10 days to provide it. If the requested information is not provided within 10 days your application will be denied

IF YOU HAVE NO INCOME

We will have to see proof of how you have been paying your bills. If a family member or friend has helped you, we need a statement completed from each person who helped you in the previous month by contributing to your household income. These forms are available at our offices.

APPLICANT’S RIGHTS

Title VI of the Civil Rights Act prohibits discrimination by anyone who receives federal funds directly or indirectly towards a beneficiary of any federally funded program. The Subgrantee must make each applicant aware of the rights and responsibilities associated with applying for and receiving LIHEAP benefits. Rights and responsibilities as reflected on the application are as follows; however, Subgrantee workers must be mindful to treat all clients with dignity, courtesy and respect.

1. I understand that my application will be shared with the providers of the selected additional services
2. I understand the information on this application will be kept confidential and only be shared as indicated. No information will be sold, loaned, rented or otherwise disclosed except as indicated on this application
3. I understand that I have the right to appeal any decision regarding this application which I consider improper, any delay in decision or delivery of services, and any disagreement with benefit amount.
4. I understand that I must help establish my eligibility by providing as much information as I can about my circumstances.
5. I authorize the LIHEAP affiliate to share information relating to my application with my utility service provider(s) to determine my eligibility or benefit amount.
6. I give permission to the Arkansas Energy Office (AEO) to use information provided on my application for purposes of reporting, research, evaluation, and analysis of the program.
7. I authorize my utility supplier(s) to release my account information to Arkansas Energy Office (AEO) or its de‐ signee(s).
8. I understand that my utility service provider will have no control over the data disclosed pursuant to this consent and will not be responsible for monitoring or taking any steps to ensure that the LIHEAP office maintains the confidentiality of the data or uses the data as I have authorized.
9. I understand that no person may be denied assistance on the basis of race, color, sex, age, handicap, religion, national origin, or political belief.
10. I understand that my signature on this application authorizes the agency to verify information about me or any household member and/or use it as a release to secure information needed to determine my eligibility for services.
11. I understand that if I receive assistance to which I am not entitled as a result of withholding information or knowingly providing false or fraudulent information regarding me and/or household members, I must repay the cost of any assistance and may face penalty of criminal prosecution.
12. The information given on this application is true to the best of my knowledge and belief. I understand that this form is signed subject to penalties for perjury

Additionally, the Subgrantee must recognize that a client has the right to request information and expect a response. The Subgrantee must not ignore inquiries related to eligible services and eligibility, payments, and rights and responsibilities.

APPEALS

AEO’s policy for hearings is based on 42 U.S. Code § 8624(b)(13), also known as LIHEAP Assurance 13, which requires that Grantees (AEO) “provide an opportunity for a fair administrative hearing to individuals whose claims for assistance… are denied or are not acted upon with reasonable promptness.”

Based on Assurance 13, AEO acknowledges that the following are reasons that applicants can file an appeal:

• The household is denied for services;
• The benefit amount is less than expected; or
• The benefit is delayed because the Subgrantee did not process the application as quickly as policy requires.

During any phase of the complaint/appeals process, the applicant may designate a representative to assist them. The applicant’s written statement, including on the Request for Appeal Hearing form, is enough to choose another person a representative to speak for him/her. Upon request for legal counsel, the applicants must be referred to Legal Aid, Arkansas Legal Services (www.arlegalservices.org), or other resources within the community.
IMPORTANT NOTE: Under state or federal law, LiHEAP benefits are not considered income or resources for any purpose, including taxation.