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 both HEAP and Weatherization at the same time.)

• LIHEAP Application Guide ( English , Spanish , Video )
• LIHEAP Application Packet (PY 2024)
• LIHEAP 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-600 Statement of Citizenship or Non Citizen Status for Public Benefits (Spanish) Rev-3-24-06
• CSD-81 Consent Form English
• CSD-81 Consent Form Spanish
• 2024 Acknowledgment Form (English and Spanish)
• CSD-43B Certification of Income and Expenses - ENGLISH
• CSD-43B Certification of Income and Expenses - SPANISH
• LIHEAP Statement of Financial Support 5.0
• LIHEAP Statement of Financial Support 5.0 (Spanish)
• Household Facts Sheet
• 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

Other Forms

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