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FriendlyCAECI Community Action of East Central Indiana, Inc.
Health and Human Services FY 2009 Poverty Guidelines
150% of Poverty (Energy Assistance)
HOUSEHOLD SIZE
MONTHLY ANNUAL
1
$1,354.00 $16,245.00
2
$1,821.00 $21,855.00
3
$2,289.00 $27,465.00
4
$2,756.00 $33,075.00
5
$3,224.00 $38,685.00
6
$3,691.00 $44,295.00
7
$4,159.00 $49,905.00
8
$4,626.00 $55,515.00
For each additional household member add
$468.00 $5,610.00
ENERGY ASSISTANCE APPLICATION CHECK OFF LIST
Check these off as you complete them.
Proof of income:
Copy of bank statement?
(direct deposit info on soc. sec., disability, retirement fund, certificate of
deposit, etc.)
Most recent award letter?
(social security, disability, V.A.)
Copy of most recent check?
(social security, disability, V.A., pension)
Copy of all check stubs or
printout of last twelve (12) months of all employment income?
Printout for unemployment
benefits, TANF, child support for the last twelve (12) months?
Household Member Verification
Form for anyone in your household 18 years of age and older and who has no
income for any or all of the last twelve (12) months? If claiming support
from someone not in your household, you will need a note from them outlining the
months and types of support they provided. Needs to be signed, name, address,
and phone number.
Contact us if you need Income Verification Forms.
Other information needed:
Copies of social security
cards for all household members?
Copy of most recent heating
and electric bills?
Copy of your lease or a
landlord statement if your heat and/or electric is included in your rent or if
you live in subsidized housing?