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Energy Assistance Check List
Energy Assistance Check List
Appointment is at 25 School Street, East Windsor

September 19, 2017 to May 1, 2018
                       Documentation required for Energy Assistance Appointment



          o           Drivers License, Birth Certificate, or Passport (for everyone in household)

o       Social Security Card (for everyone in household)

Documentation of Rent or Mortgage and Utilities

o       Current Utility Bill if you heat with gas or electricity. Verification from the utility company if you recently moved and have not yet received a bill

  •        Recent Rent Receipt and Copy of Lease (Receipt should be current - within 3 months of
            Appointment Date)  
  •       If you are a homeowner and still have a mortgage you must provide the most recent
mortgage statement

Income Verification
  •        Income - Four (4) consecutive weeks of pay stubs, two (2) consecutive if bi-weekly
pay stubs or one (1) monthly pay stub or, if theses are not available, you may bring a statement from your employer on company letterhead signed by either the employer or the payroll department stating your gross wages for the last four (4) weeks. Workman’s compensation or Disability Insurance (Short term or Long term) statement showing benefits and period covered. (Pay stubs will only be accepted if they list your name and Social Security number.)
  •        Social Security- Copy of your Social Security Check ,Copy of Bank Statement if direct
deposited, or statement from Social Security award notice (SSA-4926SM)
  •        Pension or Annuity – Copy of check, letter from the payor on letterhead of payor stating
gross amount, or copy of your 1099-R for year 2016 or 17 if under the age of 73 yrs old
  •        Since you are self-employed a notarized Self-Employment Worksheet for the last six (6)
months and current 1040 IRS form including all relevant schedules (C, D, E, SE, K, etc.)
  •        Since you are unemployed, the printout of Unemployment Compensation benefits from
the Department of Labor (DOL), or from the DOL website at: (www.ctdol.state.ct.us)
  •     Current DSS Work Sheet with your UA#
  •      Divorce decree or Family Relations Court Letter or lawyer statement verifying amount the
frequency of alimony and/or child support, Or Child Support Enforcement letter or printout, or bank statement if payments go directly to bank account, or statement from legally liable relative if voluntary cash support payments are made directly to you.
  •      VA Award letter for Veteran’s Benefits (including pensions) or a copy of your check or a
copy of bank statement if directly deposited.

            Asset Verification
  •      Asset verification is needed to verify your current account balances (s) from every
institution that you or any other household member have an account with. (Liquid assets include savings, checking account, bonds, stock/shares, CD’s, IRA’s.)  Full Statements will be needed with Name and Account number on them.  Make sure all Statements have the bank name on them also.