Byrd Barr Place Energy Assistance Application: 2022-2023 season

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Getting Started

This program cycle runs from Oct. 1, 2022 - Aug. 31, 2023.

You MUST qualify for the standard LIHEAP grant using this application FIRST if you wish to receive any secondary benefits, such as an AC unit, or Water or Rental Assistance.  You will be able to designate which secondary programs you would like to apply for later on in the application. 

*** We have run out of funding for our Rental Assistance Program.  We hope to have funding available sometime in early December.  If you are interested in Rental Assistance, please apply using this application and reach out to us in December regarding funding status.***

Please visit our website for important information such as Income Limits, Frequently Asked Questions, and a list of Required Documents you will need before you begin. 


Technical considerations before you begin:

  • There is a 35MB limit for all pictures & documents being uploaded.  This can be an issue if the images you're uploading are extremely high quality or if you live in a larger household. If you receive an error titled "REQUEST ENTITY TOO LARGE" for exceeding the maximum file size, please re-submit the application with only the uploads for your utility bill(s), and we will send you a secure upload link to attach your remaining documents separately.
  • Once you have uploaded a file from your device, you cannot change the filename on your device or the document will not be transferred.
  • If you receive errors upon submission and need help troubleshooting, please contact our Technology Coordinator @ 206-812-4950, or via email: Jacob@byrdbarr.place.  For questions regarding how to answer a question on this form, please contact energyassistance@byrdbarr.place
  • For common technical issues, please take a look at our Frequently Asked Questions
All information collected is confidential and will only be used to deem eligibility for Byrd Barr Place's internal programs. 






***MUST BE IN _________@____.___ format. If you do not have an email address, please enter none@none.com







Before we get started, let's make sure you are in our service area

"Zip codes 98106, 98181, and 9813 are split zip codes and may require being served by a different agencies."

Unfortunately, we cannot provide services to households outside of Seattle City Limits.
Please visit the Department of Commerce's website to determine your Energy Assistance Provider

 

If you are located:

NORTH of Seattle

Hopelink


8990 154th Avenue Northeast
Redmond, Washington 98052
hopelink@hopelink.org

Appointments:
425.658.2592

SOUTH of Seattle

Multi-Service Center

203 SW 153rd Street
Burien, WA 98166
info@mschelps.org

Appointments:
253.517.2263
Online

Urgent Status?

If you have not received a shutoff notice and you are primarily interested in secondary programs, please select the top option.

* While not required at this time to formally submit an application, uploading documents that verify your answers will significantly reduce the amount of time your application will take to process and greatly increase the likelihood of being awarded a grant.*

* While not required at this time to formally submit an application, uploading documents that verify your answers will significantly reduce the amount of time your application will take to process and greatly increase the likelihood of being awarded a grant.*
Tell us about yourself!
Please note that you MUST be the individual named on your household's utility bill in order to apply as the Primary Applicant




*There is a 29-character limit; please abbreviate long names such as "Martin Luther King Jr Way South APT101" to "MLK Jr Way S #101" No periods or commas.



Street address only. Put city/state below. Please include Apartment/Unit #




No parentheses or dashes necessary.




You will still receive correspondence as required to process your application.
Tell us about your home!
Home type image






*****"Your grant will be paid to you by check unless you receive a utility bill in your name, which we will need to see below*****

*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*

  • If you pay Heat With Rent, your grant will come to you as a check to the address on your lease.
  • Your landlord will need to verify that you pay Heat With Rent
  • Please fill out as much of their information below as you can
  • We will contact them on your behalf to complete the required form






***** IF YOU RECEIVE A GRANT IT WILL BE PAID AS A CREDIT ON YOUR UTILITY BILL FOR OIL, GAS OR ELECTRIC USERS. *****


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*

If you only have one energy provider, select None



No $ sign, Include decimals.

*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*

*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
Help us verify your identity

At least ONE (1) household member must have a Social Security Number to apply


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*

(MM/DD/YYYY) (09/09/1999) (must include leading 0s)

*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*







Tell us about your Income
Income limits are based on a monthly average per household, not per person* inclimits22-23_100px

*Including Self-employment, TANF, SSI, Unemployment, etc.
Help us verify your income

*** You must enter a number greater than 1 for at least one of past three months for each income source you select.***
3 Month History - Supplemental Security Income (SSI)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Social Security Administration (SSA)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Pension (Retirement)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Earned Income (Paycheck/Salary)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*With Pay dates for the most recent month is REQUIRED at a minimum.  Providing All paystubs from the past 3 months will MAXIMIZE your grant amount. *




(may be needed if uploading individual bi-weekly stubs)

3 Month History - Self-Employed (Small Business/Freelance)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Unemployment

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Temporary Assistance for Needy Families (TANF)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - General Assistance (GA)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Veteran's Affairs (VA)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Military

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Child Support

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Other

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*

Please share with us why you have not received income in the last 3 months


Declaration of No Income
I do hereby declare that I have not received any income in the previous 3 months.
I certify that the information contained above is complete and accurate to the best of my knowledge. I understand that I will be giving my signature at the end of this form that will hold under penalty of prosecution. If I knowingly give false information which results in assistance, I may be denied future services.


Tell us about the members of your household


Please complete this section for each Household Member. 

All household members 18 or over must complete their own income section(s) acknowledging their income being counted. 

At the bottom of this page is an "Add another person" button that will allow you to repeat this section for each household member. 






(MM/DD/YYYY) (ex. 09/09/1999) (must include leading 0s)


All household members that are U.S. Citizens must provide a valid Social Security Number and documentation for a complete application.


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*  If you are unable to upload any documents, you can receive a 24-hour link to upload them as soon as possible.








*Including Self-Employment, SSI, Pensions, etc.

*Providing this documentation will allow us to exclude your 18-year-old household member's income; without it, their income must be counted which will result in a lower grant amount.
Income Section

*** You must enter a number greater than 1 for each income source you select.***
3 Month History - Supplemental Security Income (SSI)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Social Security Administration (SSA)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Pension (Retirement)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Earned Income (Paycheck/Salary)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*



3 Month History - Self-Employed (Small Business/Freelance)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Unemployment

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Temporal Assistance for Needy Families (TANF)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - General Assistance (GA)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Veteran's Affairs (VA)

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Military

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Child Support

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
3 Month History - Other

Income

(Please round to nearest whole number, no "$" sign)

Income

Income


*These documents are REQUIRED for a valid application. We will allow a submission without uploading, but the application will not be considered complete until ALL verification documents are received.*
No Income Section

"School, out of work, etc."

"savings, family, etc."

BELOW IS A LIST OF SECONDARY PROGRAMS YOU MAY BE ELIGIBLE FOR:

Do you have a past due balance for WATER or SEWER charges through SPU?

If you have a Seattle Public Utilities account and you are past due, you can have your past due balance paid, up to a maximum of $2,500 during this season.

You MUST provide your most recent SPU bill showing the amount due, and you can provide additional bills later in the season to have the balance cleared again, so long as you have not exceeded the maximum amount.*

               


We cannot cover waste disposal or recycling costs.  This amount should only be the water portion of your bill.

This document is required to receive a grant. If you cannot locate your shutoff notice at this time, you can request a link to upload your documents within 1 business day.

This document is required to receive a grant. If you cannot locate your shutoff notice at this time, you can request a link to upload your documents within 1 business day.
Interested in additional assistance for Furnace Repair, Replacement or Cleaning?
We noticed that you are a homeowner:

Interested in Rental Assistance?
We noticed that you are a renter:  Byrd Barr Place offers an Eviction Prevention program for renters who have received an eviction notice.   Due to contractual obligations, we cannot begin making payments until December at the earliest, but you can still apply now to secure your place in the queue.

Please be aware: (a) Byrd Barr Place has limited funds for rental assistance. (b) Applying does not guarantee assistance. (c) Your landlord’s cooperation is required.

Interested in an Air Conditioner (A/C) Unit?
LIHEAP now offers a once-per-lifetime benefit of receiving a portable A/C unit for eligible households. 

Please be aware: indicating interest does not guarantee a unit. We will reach out to you with additional terms if eligible.
Interested in an Air Purifier?
The LIHEAP Program now offers a once per lifetime benefit of receiving a portable Air Purifier unit for eligible households.

*The governor must first declare a state-wide emergency in order for us to purchase you a unit

Please be aware: indicating interest does not guarantee a unit. We will reach out to you with additional terms if eligible.
Last Page!  Required Agreements: (LIHEAP)
LIHEAP, which stands for Low Income Home Energy Assistance Program, is a federal program that helps low income households pay for heating or cooling their homes.  In most states, it also helps people make sure their homes are more energy efficient by paying for certain home improvements, known as weatherization.
 
Most states will use LIHEAP to help you pay for your energy bill for heating or cooling your home and offer additional help in cases of energy crisis. A number of States may also offer weatherization services.

I certify that I have provided and reviewed all information on each page of this document and it is accurate to the best of my knowledge. I understand that I may be subject to criminal prosecution if I have knowingly provided false information. I further understand that I may request a Fair Hearing if the provision of the above information is not acted on to determine my eligibility within a reasonable time or if I do not receive benefits for which I feel I am eligible. I give my permission for this agency and Washington State Department of Commerce (COMMERCE) to request/release necessary information that may result in my receiving benefits from this assistance request and from similar and related programs administered by the State of Washington, including food assistance. I also give the above listed heating vendor(s) permission to establish a line of credit, and/or to release my account information to this agency or COMMERCE for current and future data analysis and eligibility determination. If the vendor is Seattle City Light, the permission to release customer billing and consumption information is allowed for up to six months from the date of this application. I understand that provision of my social security number is necessary to avoid duplicate energy assistance benefit payments to the same applicant household.  I hereby authorize energy program staff to also use my social security number for income verification purposes (including Employment Security Unemployment Insurance and DSHS Food Assistance). I further authorize this agency and COMMERCE to use my personal information within their organizations for the purpose of identifying and reporting unduplicated non-personal applicant data.

Required Agreement: PSE HELP
I certify that I have provided and reviewed the above information, which is accurate to the best of my knowledge.  I understand that I may be subject to criminal prosecution if I have knowingly provided false information.  Additionally, I hereby  authorize Puget Sound Energy, Inc. ("PSE"), this Agency, and Washington State Department of Commerce (COMMERCE) to exchange and release, disclose and make available to each other, information about me, my use of PSE products and services and/or my application for or participation in the PSE HELP program. This includes any information furnished or disclosed by me to this Agency herein or otherwise and any other information necessary or useful in assessing, documenting or confirming my eligibility or ineligibility to receive PSE HELP benefits (including Employment Security, Unemployment Insurance and DSHS Food Stamp benefits) or for current or future data analysis. I do so with full knowledge that this information is or may be confidential and as such will be protected from unauthorized disclosure. I understand that this authorization may be revoked at any time by written notice to PSE and this Agency. Until such time as I do so revoke this authorization in writing, however, this authorization shall remain in full force and effect and PSE, this Agency, and COMMERCE may rely on this authorization in exchanging, releasing, disclosing and making available to each other all such information.

Required Agreement: Energy and Money Saving Tips
Below are a few ideas to help you save money and use less energy.  To qualify for LIHEAP, you must acknowledge that you have read these tips.
  • Unplug electronic devices when not in use or when leaving home
  • Consider investing in a power strip to easily turn off multiple devices 
  • Turn off lights in rooms that aren’t being used
  • Reduce your refrigerator’s temperature (36 to 38 degrees) 
  • Make sure appliances are turned off after each use
  • Consider replacing bulbs with energy efficient lighting (CFL and LED lightbulbs)
  • Seal drafts in windows and doors with weather stripping, caulking, or plastic film 
  • Avoid using space heaters as much as possible, as they are expensive, unsafe, and not the most energy efficient when it comes to heating your entire home
  • Vacuum vents and heating baseboards regularly 
  • Add light colored curtains to windows and keep shades open during the day for sunlight and closed at night to keep warm air in
  • Consider installing a water saving shower head 
  • Lower water heaters thermostat to 120 degrees
  • Dust light fixtures regularly 
  • Take showers, not baths 
  • Run the dishwasher with full loads only and let dishes air dry 
  • Lower the thermostat every time you leave the house
  • Wash full loads of laundry with cold water, air dry clothes, and clean lint trap
  • Raise the heat temperature in your home gradually, since sudden increases will substantially increase your energy usage

REVIEW & SUBMIT YOUR APPLICATION

Upon hitting "Submit" at the bottom of this page, you MUST sign your response and provide an email.  You will receive a confirmation email with a link to verify your response's E-signature. Please check your junk folder if you do not see it in your email's Inbox.

  • If you receive errors upon submission and need help troubleshooting, please contact our Technology Coordinator @ 206-812-4950, or via email: Jacob@byrdbarr.place
But wait, Is anything missing?
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Optional Survey


Thank you for taking the time to fill out Byrd Barr Place's Energy Assistance Application.  Please click Submit to complete your application.