Information Needed To Apply For The Energy Assistance Program



Proof of income: For all members of the household 18 years and older:


Click here to print an application form. Complete the form and bring it in
with you when you apply for Energy Assistance.


You will need proof of all sources of income and proof of no income from all members in the household 18 years and older. Examples of proof of income and no income:
• Last 4 consecutive pay-stubs (if paid weekly)
• Last 2 consecutive pay-stubs (if paid biweekly or bi-monthly)

Self Employment:

• You will need the Self-employment forms that are available in our office or click here to print the form. You must fill it out prior to your appointment. The information needed for this form is the last 6 months or 12 months income and expenses of your business. It must be notarized.
• Your last year’s Tax Return

Pension and Social Security for current year:

• Either a copy of check or stub, last months bank statement showing direct deposit, or a TPQY printout.


• Printout from unemployment showing the amount paid in the last 4 weeks.
• If anyone in the household has a zero income or receives unemployment, an unemployment form must be filled out and signed. Click here to print a form.

Workers Compensation:

• Letter stating the amount received or a copy of the last four (4) checks

Budget Letter from DSS:

• Letter from DSS stating how much you receive for cash assistance

Child Support/Alimony:

• Either a copy of the divorce decree stating amount paid (weekly, monthly, etc.), a quarterly report, check stubs, bank statement (if direct deposited), or a written letter from the person who pays support to you

Friends or Relatives Support Form:

• A signed statement from a family member or friend who gives you money. It must state how much and how often. Click here for Friends or Relatives Support Form.

Rental income:

• Multi-family homeowner must show all incoming rent.

Zero Income:

• Any household members 18 or older must complete a zero income form (click here to print a form) and state how they have been living for the past four (4) weeks. They must also have an unemployment form signed to bring in our office, showing that they do not receive unemployment.


Proof of Primary Source of Heat:

• Oil For oil heat you must have the name of your oil vendor and make sure they are participating in the program before your appointment.
• Yankee Gas or Electric For electric or gas you must have your current Yankee Gas or CL&P bill. The bill must be in the name of a family member age 18 or older who resides in the home and must be charged to your current address.

You will need copies of the following:

• Full 30-day bank statements for all accounts that show current balances (checking and savings). Bank statement must have bank logo on it and show your name and address. Be sure to have all pages. If the statement states page 1 of 5 pages, all five pages are needed even if one page is blank.
• Proof of all stocks, CDs, Bonds, and IRA’s (IRA’s if you are 59 ½ or older)
• Rent Receipt and Lease (only if heat is included in the rent)

You will need to know the following information:

• Social Security numbers for everyone in the household
• Dates of birth for all family members