Application for Financial Help to Heat or Cool Your Home

Program Year 2024

Low Income Home Energy Assistance Program (LIHEAP)

How to apply for LIHEAP

  1. Fill out the application below. For each section, read the instructions carefully, answer every question, and gather the required documents (extra papers) you need to turn in with your application. If your application is not complete, it could be delayed or turned down.
  2. Send your completed application and extra papers to the LIHEAP agency that processes applications in the county you live in. See “Where to Send Your LIHEAP Application”. This is found on the last page of this application.

When to apply for LIHEAP - Energy Assistance (EA)

  • Send your application on or after Oct. 1st if: Any member of your household is age 60 or over, or if any household member is disabled. You may need to send extra papers with your application to show that your household has someone age 60 or over, or who is disabled.
  • Send your application on or after Nov. 1st if: Your household doesn’t include a person age 60 or over, or who is disabled.

When to apply for LIHEAP - Energy Crisis Intervention Program (ECIP)

  • You can ask for Winter ECIP from November 1st - May 31st for elderly/disabled households and December 1st - May 31st for all other households.
  • You can ask for Summer ECIP from June 1st - September 30th.

How to apply for ECIP (Crisis)

  • If you are in crisis and have already applied for EA this program year (October - September), reach out to your local contracted agency for further assistance. If you need further information about ECIP, visit our website at: www.mydss. mo.gov/utility-assistance.
  • If you are in crisis and have not applied for EA this program year (October - September), you will need to fill out the 
entire application.

After you send your application

The LIHEAP agency will review your application and extra papers you provided:

  • If your application is not considered a crisis, the agency will review it within 30 working days after they receive it.
  • Department of Social Services will send you a letter by mail that tells if you qualify for LIHEAP and the amount you’ll get. The amount you are approved for may be reduced if you owe the Missouri Department of Social Services, Family Support Division LIHEAP any overpayments from previous years.

Important:

  • Even after you apply for Energy Assistance, continue to pay your heating or cooling bill so you don’t get disconnected.
  • When you pay your energy bill, send it to the utility company that sent you the bill, not the LIHEAP agency. LIHEAP agencies will only process your application. They will never accept utility payments, fees, or co-payments.
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PROGRAM DESCRIPTION

ENERGY ASSISTANCE (EA)

HOUSEHOLD

MONTHLY INCOME AMOUNTS

One time payment towards the utility bill of your choice from November 1 through May 31.

SIZE

 

0%-60% STATE MEDIAN INCOME (SMI)

Natural Gas

$326

1

$0-2,535

Tank Propane

$495

2

$0-3,315

Electric

$318

3

$0-4,095

Fuel Oil

$326

4

$0-4,875

Wood

$219

5

$0-5,655

Kerosene

$153

6

$0-6,435

Cylinder Propane

$177

7

$0-6,581

ENERGY CRISIS INTERVENTION PROGRAM (ECIP)

8

$0-6,727

Winter

Up to $800 November 1 through May 31 with a disconnect notice

9

$0-6,874

Summer

Up to $600 June 1 through September 30 with a disconnect notice

10

$0-7,020

Where to send your LIHEAP Application

Search for your local office by referring to the county in which you live.

Audrain, Boone, Callaway, Cole, Cooper, Howard, Moniteau, Osage

Central Missouri Community Action (CMCA)

800 N Providence Rd Ste 200

Columbia, MO 65203-4300

Phone number: (573) 443-1100 Fax (573) 370-1212

Jefferson, Franklin

Jefferson-Franklin Community Action Corporation (JFCAC)

PO Box 920

Hillsboro, MO 63050-0920

Phone number: (636) 789-2686 Fax (636) 789-2866

www.jfcac.org


St. Louis County

Community Action Agency of St. Louis County (CAASTLC)

2709 Woodson Rd

Overland, MO 63114-4817

Phone number: (314) 446-4420 Fax (314) 446-4480

Camden, Crawford, Gasconade, Laclede, Maries, Miller,

Phelps, Pulaski

Missouri Ozarks Community Action, Inc. (MOCA)

PO Box 69

Richland, MO 65556-0069

Phone number: (573) 765-3263 Fax (573) 765-0026


Andrew, Buchanan, Clinton, DeKalb

Community Action Partnership of Greater St. Joseph

(CAPSTJOE)

1322 N. 36th St.

St. Joseph, MO 64506

Phone number: (816) 233-8281 Fax (816) 233-8262

IVR: (816) 693-6868

Carroll, Chariton, Johnson, Lafayette, Pettis, Ray, Saline

Missouri Valley Community Action Agency (MVCAA)

1415 S Odell Ave

Marshall, MO 65340-3144

Phone number: (660) 831-5331 Fax (660) 831-5039


Atchison, Gentry, Holt, Nodaway, Worth

Community Services, Inc. of Northwest Missouri (CSI)

PO Box 328

Maryville, MO 64468-0328

Phone number: (660) 582-3113 Fax (660) 582-2965

Lewis, Lincoln, Macon, Marion, Monroe, Montgomery,

Pike, Ralls, Randolph, Shelby, St. Charles, Warren

North East Community Action Corporation (NECAC)

805 Business Highway 61 N

Bowling Green, MO 63334-1351

Phone number: (573) 324-0120 Fax (573) 213-4858


Barton, Jasper, Newton, McDonald

Economic Security Corporation of Southwest Area (ESC)

PO Box 207

Joplin, MO 64802-0207

Phone number: (417) 781-0352 Fax (417) 781-2011

Adair, Clark, Knox, Schuyler, Scotland

Community Action Partnership North East Missouri

(CAPNEMO)

PO Box 966

Kirksville, MO 63501-0966

Phone number: (660) 665-9855 Fax (660) 665-6557


Bollinger, Cape Girardeau, Iron, Madison, Perry,

St. Francois, Ste. Genevieve, Washington

East Missouri Action Agency (EMAA)

PO Box 308

Park Hills, MO 63601-0308

Phone number: (800) 392-8663 Fax (573) 431-7377

Douglas, Howell, Oregon, Ozark, Texas, Wright

Ozark Action, Inc. (OAI)

710 E Main St

West Plains, MO 65775-3307

Phone number: (417) 256-6147 Fax (417) 256-0333


Dunklin, Mississippi, New Madrid, Pemiscot, Scott,

Stoddard

Delta Area Economic Opportunity Corporation (DAEOC)

99 Skyview Rd

Portageville, MO 63873-9180

Phone number: (573) 379-3851 Fax (573) 379-9139

Barry, Christian, Dade, Dallas, Greene, Lawrence, Polk,

Stone, Taney, Webster

Ozarks Area Community Action Corporation (OACAC)

215 S Barnes Ave

Springfield, MO 65802-2204

Phone number: (417) 864-3460 Fax (417) 864-3472


Barry, Christian, Dade, Dallas, Greene, Lawrence, Polk,

Stone, Taney, Webster

Ozarks Area Community Action Corporation (OACAC)

215 S Barnes Ave

Springfield, MO 65802-2204

Phone number: (417) 864-3460 Fax (417) 864-3472

Caldwell, Daviess, Grundy, Harrison, Linn, Livingston,

Mercer, Putnam, Sullivan

Community Action Partnership North Central Missouri

(CAPNCM)

1506 Oklahoma Ave

Trenton, MO 64683-2587

Phone number: (660) 359-3907 Fax (660) 359-2038


Butler, Carter, Dent, Reynolds, Ripley, Shannon, Wayne

South Central Missouri Community Action Agency (SCMCAA)

PO Box 6

Winona, MO 65588-0006

Phone number: (800) 325-4633 Fax (573) 325-4543

City of St. Louis, Wellston

Urban League (ULSTL)

1408 N. Kingshighway Blvd.

St. Louis, MO 63113

Phone number: (314) 615-3632 Fax (314) 615-3632


Jackson, Clay, Platte

Mid America Assistance Coalition (MAAC)

4001 Dr. Martin Luther King JR. DR., Suite 270

Kansas City, MO 64130-2350

Phone number: (816) 768-8900 Fax (816) 768-8901

Part 1 – Contact Information/Address Corrections

Fill in your current home address or make any necessary corrections if the home address on the application is not current. 
Also, if possible, please list a phone or message number so we can contact you if we have questions. This will help avoid 
delays as we review your application. * Indicates the field is required.


Office: {Office}

Address: {Address}

City State Zip: {CityStateZip}

Phone Number: {PhoneNumber}

If you have problems uploading any of your attachments, please send email to {Email}

  • Applicant’s whose heating or cooling has been disconnected or may be disconnected soon:
    • Send a copy of your disconnection notice along with the fuel statement or utility bill mentioned above, and
    • If you or someone in your household suffers from a life threatening medical condition, send a medical statement from a qualified doctor or nurse. The statement should say that the person has a life-threatening medical condition, but does not have to state a diagnosis or condition.
Part 4 - Utility Information
  • DSS will only pay EA as a one-time payment towards one (1) fuel type per program year (October -September.)
  • Indicate in the “Fuel Source For My Home” section below, the fuel type you are asking your EA payment to be paid towards if you are approved for benefits.
Part 4 - Additional Utility Information
Part 5 - If You Don’t Pay The Utility Company Directly

Fill in this section if you don’t pay your energy bill directly to the utility company.

Part 6 - Income You Earn Or Pay For Child Support

If anyone in your household has income from a job or self-employment:

  • Fill in this section to show all income anyone gets from tips, payments for service, and wages for all jobs, even if someone has more than one job, and
  • Send copies of papers that show all gross income received by anyone last month, such as paystubs. Gross income is income received before taxes are withheld. If anyone was employed in the last six (6) months, but did not receive income from that job last month, we may need proof of final wages earned and last date worked from that employer.

List everyone in your home age 18 or older who received income from a job last month. (Include all jobs.)

Part 6 - Income You Earn Or Pay For Child Support Continued

If yes, send a copy of the most recent Federal Income Tax Form 1040, including Schedule 1, for each self-employed person along with your application.

Court-ordered Child Support that is paid to someone outside your household can be deducted so that it doesn’t count as income. To receive this deduction, fill in your 8-digit Child Support case number below.

Part 7 - Income That Isn’t Earned

If anyone in your household receives income that does not come from a job or self-employment:

  • Fill in this section, and
  • Send copies of papers that show all unearned income anyone received last month.
Social Security

Supplemental Security Income (SSI)

Temporary Assistance for Needy 
Families (TANF)

Supplemental Aid to the Blind (SAB)

Blind Pension (BP)

Supplemental State Payments (SSP)

Foster Care

Alimony

Child Support

Part 7 - Income That Isn’t Earned Continued
Unemployment Compensation

Veterans Benefits

Pensions

Railroad Retirement

Rent Received from Land or Buildings

Money Received from Friends, Family,
or Organizations

Armed Forces Allotment

Union Funds or Strike Benefits

Worker’s Compensation or Temporary Private Disability

Other Unearned Income
Part 8 - Savings And Other Accounts

If anyone in your household has savings or other accounts, fill in the total amounts of money everyone has in each type of account.

Part 9 - Notice That You Can Get A Fair Hearing - For Informational Purposes Only

As an applicant for the Low Income Home Energy Assistance Program (LIHEAP), you may request a hearing for the 
following reasons:

1)     If your LIHEAP application is denied.


2)     If your LIHEAP application is not reviewed timely.

A request for a hearing can be made in writing, by phone, by fax, or in-person.

Papers you must send with your application to avoid processing delays (send copies, originals will not be returned):

Papers you need to send if any member of your household got any income last month:

Part 10 - Your Consent For The LIHEAP Agency To Process (Review) This Application

Read the Consent for Processing in the box below and sign. If you do not sign and date the application, your LIHEAP application will not be processed.

I hereby apply for assistance under the LIHEAP laws of the State of Missouri administered by the Department of Social Services (DSS). I declare that the information I have given is true, correct, and complete to the best of my knowledge. I realize that the information which I have given on this application will need to be verified by the LIHEAP agency.

If any household member declared on my application is currently receiving SNAP, TANF, or Child Support, I hereby authorize the LIHEAP agency to use my Family Support Division (FSD) file to see if we qualify for LIHEAP. I hereby authorize the LIHEAP agency, FSD, and my fuel supplier to provide to one another any of my customer, application and account information (such as: service address, energy source, customer account number, past due amount, notice of disconnection, etc.) to determine my eligibility and to otherwise administer the program. to determine my eligibility and to otherwise administer the program. I give permission to DSS to use information provided on this form for purposes of research, evaluation, and analysis of the program.

I understand that I may be fined, imprisoned, or both under state or federal law if I make false statements on this application in order to get benefits I am not entitled to receive.

    Thank you for submitting your application for the Low Income Home Energy Assistance Program (LIHEAP).  Below you will find information on how long it might take to process your application.  If you have any questions or would like a status update, please contact your local LIHEAP agency.

    LIHEAP agencies:

    https://dss.mo.gov/fsd/energy-assistance/pdf/liheap-contracted-agencies.pdf

    Your Form ID is: {formuniqueid}.

    Processing Timeline:

    LIHEAP Application Timeline: Day 1 LIHEAP is received, Day 3 LIHEAP Application is registered in system, Day 30 LIHEAP Application is fully processed within 30 days, Day 31 Listing is made for pledge approval, Day 45 Supplier responds with approve or denail of pledge, Day 60 if approved will send payment to supplier if approved within 15 calendar days.