The federally funded Low Income Home Energy Program (known as Fuel Assistance Program) provides certified eligible households with assistance in paying their energy bills during the winter season. Households where elderly, disabled persons and/or children under the age of 6 reside can apply for assistance beginning July 15, 2014. All other households may apply beginning September 1, 2014. Fuel assistance season ends April 30, 2015.
Benefits are calculated on a number of things, including household income, energy costs, and housing type. This allows those households with the lowest incomes and highest energy costs to receive the highest benefits. Applications are taken through our Community Services Offices in Dover and Farmington. Please note: Households can also apply for and receive electrical assistance at the same appointment, if eligible.
Fuel Assistance Forms
- Landlord Form
- Self-Declaration of No/Low Income Form
- Employment Release Form
- Child Support Verification Form
- IRS 4506-T Form (verification of non-filing)
Required Document Checklist
Please use this checklist to be sure that you have included all of your documentation. Incomplete applications will not be accepted or will be denied.
Copies of all gross income (income prior to deductions/taxes) for everyone in the household for the last 30 days prior to your application date.
- 5 pay stubs if paid weekly
- 3 pay stubs if paid bi-weekly
- 2 pay stubs if paid monthly
Income examples: Employment, Pensions, Social Security, SSI, SSDI, TANF, APTD, Gross Civil Service Income, Child Support, Disability income, Unemployment, Worker's Compensation, Bank Interest over $100 per year
NH Department of Health and Human Services Notice of Decision: If you receive assistance from DHHS (such as food stamps, Temporary Assistance for Needy Families, Aid to the Permanently Totally Disabled, etc.), you will need a copy of your most recent decision letter.
No Income: Anyone age 18 and older with no income and is not in high school, will need to come to the nearest Community Services Office to fill out a No Income form, which must be signed in front of one of our outreach staff.
Copy of 2013 Tax Return: All applicants must bring in a copy of their complete IRS Tax Return (the actual form 1040, 1040A, 1040EZ) filed with the IRS. If anyone in the household did not file a tax return, they will need to fill out the enclosed IRS Tax Form 4506-T, and send it to the IRS for verification of non-filing.Your application will not be complete until this verification from the IRS has been received.
Self-employed: All applicants who are self employed must bring a copy of their signed 2013 Tax Return along with the Schedule C or SE. If anyone in the household did not file a tax return, they will need to fill out the enclosed IRS Tax Form 4506-T, and send it to the IRS for verification of non-filing. Your application will not be complete until this verification from the IRS has been received.
Renters: All renters are required to have the enclosed Landlord/Tenant Verification Form filled out by his or her landlord, and returned with this application (this form does not apply if you own your mobile home and pay lot rent).
Copies of Social Security Cards and Birth Dates for everyone in the household. Birth certificate are not required.
Fuel Dealer Name and Account Number will need to be established before your appointment. If you heat with natural gas, we will need a copy of your current Unitil bill.
Copy of Current Electric Bill
Please keep in mind that not all circumstances can be addressed. If you have an unusual circumstance, questions or are unsure of what to do, please call your closest Community Services Office at 603-460-4237 (Dover) or 603-460-4313 (Farmington)
New Hampshire Electronic Application System (to apply for cash or child care assistance, Medicaid, food stamps and Medicare Savings)