INSTRUCTIONS For assistance, please call 1-800-246-4221. - Complete all sections of the application.
- All household members that are 18 years of age or older, including you, must sign and date.
- Gather the following items to submit with your application:
- A copy of your recent main heating bill and your electric bill. The bill(s) or statement(s)must show the service address, account number, and name.
- If you rent, your Landlord needs to complete the LIEAP Rental Verification form.
- If you receive rental assistance, we must receive a printout from your local Housing Authority office showing the utility allowance.
- Provide proof of GROSS income for everyone in the household; the three most recent consecutive pay stubs for each person in the household; or an Employers Statement form, which you can get from Align.
- If anyone in the household receives Social Security benefits: provide a copy of the Social Security benefit award letter or Tax Form SSA – 1099 Social Security Benefit Statement.
- If anyone in the household receives pensions, retirements, and/or annuities: provide a copy of the benefit letter or tax form 1099. (A bank statement cannot be accepted.)
- If anyone in the household is self-employed provide a copy of the most recent self-employment tax return forms and appropriate Schedule or a Profit and Loss Statement(prepared by you, a tax advisor or an accountant).
- Provide proof if anyone in the household receives Income from Alimony/Spousal Maintenance, POWER/TANF benefits, Unemployment Benefits, Veteran’s Benefits, Workers’ Compensation/Disability/Illness benefits.
- If money is received from others, include a signed and dated letter from the person(s)stating frequency and amount.
- If there is no income in your household, provide a statement explaining how expenses are being paid OR complete a LIEAP Self Declaration of Zero Income form fillable Electronic Form.
- If anyone in the household is unemployed, please provide a completed and signed workforce registration form from the Wyoming Workforce Services.If you are receiving unemployment benefits attach a copy of your unemployment benefit report.
- Proof of identification for all NEW household members, which may be a copy of just one of the following: Driver’s license, social security card, birth certificate, medical insurance card, military ID, State issued ID, Passport, current school record(s) or school ID, permanent resident card, registered alien card, crib card.
- If anyone in the household is a College student that has no income provide proof of full time class registration.
- If anyone in the household is 18 or older and is a High School studentprovide proof of school attendance.
- If you appoint an authorized representative provide a copy of their identification and complete the authorized representative portion of the application on page 1.
- Submit completed application with ALL supporting documents by any of the following ways:
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