Divernon, IL · Sangamon County
LIHEAP Assistance Application
This application is for Divernon households seeking LIHEAP energy assistance and asks applicants to provide household, income, and utility information.
What this form is
Use this application to request LIHEAP assistance. It asks for household members’ names, birth dates, Social Security numbers, income, and utility information, and the instructions list supporting documents such as proof of income and utility bills. The form also includes statements about the accuracy and disclosure of the information provided.
Who needs it
Divernon residents seeking LIHEAP assistance should complete the application and provide the household and income information requested.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed and dated without a notary; the instructions list supporting documents, but do not say any attachment must be notarized or sworn.
How to submit this form
- 1
Download The Application
Download the LIHEAP Assistance Application PDF.
- 2
Complete The Application
Fill in the requested household, income, and utility information, then sign and date the application.
- 3
Gather Supporting Documents
Gather the supporting documents listed in the instructions, such as proof of income and utility bills.
- 4
Submit To The City
Submit the application to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What is the LIHEAP Assistance Application for?
- It is used to request LIHEAP assistance and provide household, income, and utility information.
- What information and documents does the application request?
- It asks for household members’ names, birth dates, Social Security numbers, income, and utility details. The instructions list supporting documents, including proof of income and utility bills.
- Do I need a notary for the LIHEAP Assistance Application?
- No. This document is signed and dated without a notary. The instructions list supporting documents but do not say any attachment must be notarized or sworn.
- How do I submit the LIHEAP Assistance Application?
- Submit it to the city department named on the form; check the city website for current contact details.