Electronic Signature Forms

LIEAP Application

Your application cannot be processed until you submit your electronic signature using the link(s) below.

Application Signatures

Authorized Rep Signatures

Fillable Electronic Forms

Self Declaration of Zero Income

Downloadable PDF Forms

These are forms you may need to complete your application to receive assistance.
Questions? Call us at 1-800-246-4221 for help.

Employer Statement

Work Registration Verification

Rental Verification

Statement of Incapacity

Self Declaration of Permanently Parked TRADITIONAL DWELLING