FY19 LiHEAP Application Forms
Those applying for HACAP's Energy Assistance (LiHEAP) program can download the "FY19 LiHEAP Application" form below along with a set of instructions for completion and a list of HACAP Sites that will be accepting completed applications.
For questions, call the Energy Line at (319) 739-0100
The Low-Income Home Energy Assistance Program (LIHEAP) is designed to assist low-income families meet the cost of home heating. This program is not intended to pay a household's total energy costs, but to pay a portion of residential heating costs for eligible households. In most cases, benefits will be in the form of a credit applied to your utility company heating bill. All persons applying for this program will simultaneously be making application for Weatherization Assistance as required by state law.
These instructions are intended to assist households in gathering the documents needed to complete an application which must be presented in person at a Hawkeye Area Community Action Program (HACAP) location for processing.
Applications are accepted on a first come/first served basis from November 1 through April 30 (October 1 through April 30 for households with an elderly or disabled member or have a disconnect notice or are disconnected). HACAP will send a Notice of Approval or Denial to all applicants within 30 days of application. The initial determination of eligibility and benefit amount is subject to review, and payments are dependent on the availability of federal funds.
A household may qualify for assistance in this program if the total income of all persons living in the home falls within the income range listed below. It is necessary to provide documentation of all household income for the last 13 weeks or the last 12 months/calendar year, and a copy of most recent heating and electric bills.
Households who reside in subsidized housing and are responsible for paying their primary heating costs may be eligible. Households who reside in subsidized housing and have heat included in their rent are not eligible.
Residents of any licensed medical facility (hospital, skilled nursing facility or intermediate care facility), publicly operated community residence, or emergency shelter are not eligible unless they are paying a vendor directly for their primary heating source.
|Size of Household||Annual Household Income|
For households with more than 6 members, add $7,280 for each additional member.
Proof of Income
To apply for LiHEAP, you will need to provide documentation of all household income, including:
Wages, self-employment or farm income, FIP, Social Security, SSI, VA benefits, pensions, unemployment insurance, workers compensation, strike benefits, child support, alimony, General Assistance payments, training stipends, regular insurance or annuity payments, periodic receipts from estates or trusts, military family allotments, net rental income, net royalties, and net gambling or lottery winnings.
**IF YOU HAVE A DISCONNECT NOTICE PLEASE CONTACT YOUR ENERGY VENDOR IMMEDIATELY AND LET THEM KNOW THAT YOU ARE APPLYING FOR LIHEAP. AT THE TOP OF YOUR APPLICATION PLEASE WRITE "DISCONNECT NOTICE" AND THE DATE AND NAME OF THE PERSON YOU TALKED TO WHEN YOU CALLED YOUR ENERGY VENDOR AND GET YOUR APPLICATION TO HACAP AS SOON AS POSSIBLE. CALL OUR OFFICE IMMEDIATELY IF YOU RECEIVE A DISCONNECT NOTICE AFTER YOU HAVE SUBMITTED YOUR APPLICATION.**