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Income Guidelines &

                                 Application Requirements

      Eligibility is determined by the last 30 days of gross income. Monthly income cannot exceed the amount
      listed below for the number of persons living in the household:

         1 person         2 persons         3 persons         4 persons         5 persons         6 persons         7 persons

          $2,170            $2,838           $3,506             $4,174            $4,842            $5,510            $5,635

      Required Documents: Utility Bill

      Submit a copy of ALL PAGES of the most recent energy bill.
       Utility Account:                         Submit copies of:

       Gas & Electric (PG&E)                    ALL pages of most recent bill and shutoff notice if applicable.
       Wood or Propane Account                  Recent statement or invoice and a copy of the most recent utility bill.

       Sub-Metered Utilities                    Most recent rent receipt showing gas and electric costs.

                                                Letter from landlord stating the total amount of rent that goes
       Utilities Included in Rent
                                                towards monthly energy costs OR a CCES Certification Form

      Required Documents: Income

      Submit  copies  of  income  documents  for  the  LAST  30  DAYS  for  ALL  adults  in  the  household  receiving
                    Complete HEAP applications
      income or aid. Adult household members with no income must submit a written statement explaining
      how they support themselves in absence of income.

       Income Received:                         Submit copies of:

                                                Current copy of paycheck stubs covering one full month (if paid weekly last
       Wages/Earned Income                      4  pay  stubs;  if  paid  bi-weekly  last  2  pay  stubs),  letter  or  printout  from
                                                employer with gross amount and pay period.
                                                Copy of current check, most recent bank statement showing direct deposit,
       SSI/SSP/SSA                              current annual benefit letter, payee letter showing income amount, Form
                                                4926, Form 2458, HUD statement with a SS amount.
       Pensions, Annuities,                     Current  copy  of  check,  pension  verification,  annual  statement,  bank
       Interest/Dividend Income                 statement showing direct deposit.
                                                Current copy of check, Notice of Action, Passport to Services, verification
       General Assistance/                      from worker with amount & date, food stamp verification, or aid summary,
                                                CalFresh award letter.
       Workers Comp., Disability,               Current copy of checks/check stub, printout, or award letter
       Unemployment Benefits

                                                Current  court  document,  copy  of  check,  current  signed  statement  from
       Child/Spouse/Individual Support
                                                person providing report, notice of action showing support

                                                Current copy of check, benefit letter, letter of verification from VA, or copy
       Veteran's Benefits
                                                of bank statement showing direct deposit
                                                Copy of ledger/journal, signed self-employment statement showing month,
                                                gross receipts, gross expenses and net income, 1040 form
                                                Written  statement  for  odd  jobs  with  dollar  amounts  and  dates,  current
                                                receipts for recycled materials.
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