This page contains a variety of helpful resources and commonly used forms. Download and review these forms before contacting us.

 

APPLICATION PACKETS

(NOTE: a completed application packet with supporting documents is REQUIRED TO APPLY FOR ALL PROGRAMS)

ALL PROGRAMS APPLICATION PACKET

(Complete this packet to apply for ONE PROGRAM, or ALL THREE PROGRAMS at the same time: HEAP, Weatherization, and/or Water Assistance.)

• LIHEAP Application Guide ( English , Spanish , Video )
• LIHEAP Application Packet (PY 2023)
• LIHEAP Documentation Checklist

WATER ONLY APPLICATION PACKET (Complete this application to apply for Water Assistance only.)

• LIHWAP Application Packet
• LIHWAP Documentation Checklist

Water Tips and Other Programs

• Water Conservation Tips
• California Water Boards assistance program

 

APPLICATION REPLACEMENT FORMS

(NOTE: these forms are TO BE USED INDIVIDUALLY AS NEEDED. TO APPLY FOR SERVICES, YOU MUST COMPLETE and submit an APPLICATION PACKET and submit supporting documentation.)

HEAP and Weatherization Forms

• CSD-43 Energy Intake Form (English)
• CSD-43 Energy Intake Form (Spanish)
• CSD-600 Statement of Citizenship or Non Citizen Status for Public Benefits Rev-3-24-06
• CSD-81 Consent Form English
• CSD-81 Consent Form Spanish
• CE CSD-321 2023 Acknowledgment Form (English)
• CE CSD-321 2023 Acknowledgment Form (Spanish)
• CSD-43B Certification of Income and Expenses - ENGLISH
• CSD-43B Certification of Income and Expenses - SPANISH
• LIHEAP Statement of Financial Support 3.0
• Application Referral Source
• PG&E CARE Online Enrollment
• Home Energy Conservation Tips
• Make a Budget Worksheet
• CSD-51 SWEATS Intake Form (For use only during declared extreme weather conditions)

Weatherization Forms

• Weatherization Intake Form
• Weatherization Intake Form - Spanish
• CSD-515A Energy Serv Agreement - Occupant-2-12-16392
• CSD-515B Energy Serv Agreement - Prop-Owner-2-12-16798

Water Assistance Forms

• CSD-41 LIHWAP Intake Form (English)
• CSD-41 LIHWAP Intake Form (Spanish)
• CSD-43A LIHWAP Intake Addendum Form (English) [Complete this form if you have a pending HEAP application or if you received a HEAP Benefit in the past 120 days.]
• CSD-43A LIHWAP Intake Addendum Form (Spanish)
• CSD-040 LIHWAP Landlord/Management Agreement

Other Forms

• Service Referral and Follow-Up Summary
• SOC341--Report Elder Abuse Form
• SOC342--Report Abuse for Financial Institutions
• Community Center Rental Application