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Financial Opportunity Center
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LIHEAP Form
"
*
" indicates required fields
Full Legal Name
*
Social Security Number
*
Address
*
Street Address
Address Line 2
City
Audrain
Boone
Callaway
Cole
Cooper
Howard
Moniteau
Osage
County
Zip Code
Email
*
Enter Email
Confirm Email
Are you currently without services?
*
Yes
No
What type of documents are you uploading? (select all that apply)
*
Full completed LIHEAP application
Copy of social security card for one, or more, household members
Income documents (wage documentation form, Low Income Interview Guide, pay stubs, Social Security benefits award letter, termination letter, etc)
Additionally requested documents in a letter you received from the CMCA Energy Department
Landlord form
Copy of utility bill(s)
Copy of Non-Energy Form & Receipt
Change of address application
Change of utility company application
Change of household member application
Other (please specify)
Select All
Please specify what other documents you plan to upload.
*
Attach your documents
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Attach your documents
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Add your files
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Terms
*
I understand that this form I completed today is not the LIHEAP application.
I understand that this form I completed today is not the LIHEAP application. If you need to complete the LIHEAP application, please
submit directly through the DSS online form
.
