3001-2      THE APPLICATION FORM

3001-2 A.      WHAT IS AN IDENTIFIABLE APPLICATION FORM?

An identifiable application is an acceptable application form containing the applicant's name, address, and signature (or witness mark) of the individual seeking assistance or of the individual's authorized representative. Each DPADivision of Public Assistance office must accept and date the identifiable application when it is presented.

NOTE:

Tribal Energy Assistance applications are considered "acceptable" and must be registered, processed, filed in the client's ILINX folder, and a copy of the application forwarded to a tribal agency if applicable.

3001-2 B.      WHO CAN SIGN THE APPLICATION FORM?

• Any adult household member
• An authorized representative
• An individual who has legal authority to act on the applicant's behalf (i.e., Office of Public Advocacy, legal guardian)
• An individual with appropriate power of attorney

The signer must certify, under penalty of perjury, the truth of the information contained in the application.

3001-2 C.      WHO CAN BE AN AUTHORIZED REPRESENTATIVE?

A responsible adult, 18 years or older, may be designated by the applicant in writing as an authorized representative. Authorized representatives may sign the application and act on behalf of a household. A household member should prepare or review the application, if possible, even though the authorized representative will be filing the application.

The household may designate an emergency authorized representative (no age limit) if the need arises. The emergency authorized representative can obtain benefits on those occasions when, due to an emergency, neither a household member nor the authorized representative is able to do so. A separate written designation is needed each time an emergency authorized representative is requested to act for the household.

The household is liable for any overpayment resulting from erroneous information provided by an authorized representative.

If the applicant is illiterate, his/her mark must be witnessed by two individuals who must each sign their names and date the document. No special form is required.

3001-2 D.      WHO CANNOT BE AN AUTHORIZED REPRESENTATIVE?

Vendors authorized to accept heating assistance benefits, fee agents, or DPADivision of Public Assistance employees involved in the certification or issuance process may not be authorized representatives without the written approval of the Director or Chief of Policy & Program Development.

3001-2 E.      COMPLETING THE APPLICATION FORM

In addition to submitting an identifiable application and having it signed by an eligible individual, the applicant must answer all of the questions on the application form.

If the individual requests help in completing the application form, the worker will offer assistance.

If the application form is not completed, the heating assistance worker will allow the household an opportunity to complete the form. In this case, a written notice, known as a pend notice of action, will be sent to the household listing the items that need to be completed.

3001-2 f.      COMPLETE APPLICATION

A completed application includes:

1. Responses to HAPHeating Assistance Program application form questions, including the full names, birth dates, and social security numbers of all household members;
2. The head of household's signature, and the date the application was signed.
3. Proof of gross income from all household members;
4. A copy of the current heat and electric bills if the applicant pays for home energy directly, and/or wood vendor receipt totaling $200 or more, and/or a copy of receipts showing supplies purchased for self-harvesting wood;
5. A copy of the rental agreement and a recent rent receipt if the applicant rents and heat is included in their rent; and
6. Proof of ID including a driver's license, state-issued ID, CIBCertificate of Indian Blood card, BIABureau of Indian Affairs card, or tribal enrollment card.

3001-2 G.      TRIBAL APPLICATIONS

Some tribal organizations serve Alaska Native and American Indian (and in some cases non-native) households in their communities. ECOSEnergy Community Online System is designed to alert the caseworker when an application meets this criteria. At registration, ECOSEnergy Community Online System flashes an alert indicating that the applicant appears eligible to be served by another agency and denies the application.

NOTE:

Auto denied applications must be filed in the client's ILINX folder and a copy of the application forwarded to the applicable tribal agency.

ECOSEnergy Community Online System will allow the entry of households containing both Native and non-Native members. When the household consists of both Native and non-Native adults, HAPHeating Assistance Program will serve the household if the head-of-household is non-Native. Caseworkers processing applications containing both Native and non-Native household members must check with the appropriate tribal organization to make sure the family has not already been served by that organization. If they have been served, the application is denied and the information received from the tribal organization is entered in the case note. If the household has not been served by a tribal organization, the caseworker should notify the tribal organization that HAPHeating Assistance Program will serve the household.

When a tribal organization refuses service to a household that appears to meet their eligibility criteria the caseworker must bring the situation to the attention of hss.dpa.policy@alaska.gov for resolution.

NOTE:

Applicants who are determined ineligible for tribal HAPHeating Assistance Program for failure to follow the rules of their tribal organizations, e.g., failure to submit an application during the tribal HAPHeating Assistance Program enrollment period are NOT eligible to receive HAPHeating Assistance Program through DPADivision of Public Assistance.

Applicants who fail to submit an application through their tribal organization while funds are available are NOT eligible to receive HAPHeating Assistance Program through DPADivision of Public Assistance.

3001-2 H.      VOTER REGISTRATION APPLICATIONS

The National Voter Registration Act requires that all states that provide public assistance must offer voter registration opportunities. The heating assistance application now includes a voter registration application and a declaration.