Complete LIHEAP Application Form (En)

Illinois Low Income Home Energy Assistance Program (LIHEAP) / Illinois Home Weatherization Assistance Program (IHWAP)


Need Additional Assistance Contact PCCEO At: (309) 671-3900.

APPLICATION DISCLAIMER:

Before you are allowed to submit your application, the application MUST have ALL the required documents uploaded for your application to be completed and accepted. Required documents: Social Security Card for everyone in household, Gross income for all household members including SSI, SSA, SSDI, Retirement or Pension and Most recent Ameren bill in your Name.

Head of Household:










ADDITIONAL HOUSEHOLD MEMBERS:









ADDITIONAL HOUSEHOLD MEMBERS:









ADDITIONAL HOUSEHOLD MEMBERS:













ADDRESS:











SUPPLEMENTAL QUESTIONS:









Please read and Sign:

IMPORTANT NOTICE: This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under the Low Income Home Energy Assistance Act of 1981 as amended. Disclosure of this information is REQUIRED. Failure to provide any information will result in this application not being processed. This application has been approved by the State Forms Management Center.

Applicant Statement: I certify that the information I have provided above is an accurate and complete disclosure of the requested information. I also certify that every household member in the application is either a US citizen or legal resident according to the LIHEAP/IHWAP rules. I authorize this agency to verify the information and contact my utility/fuel supplier, landlord, employer and/or other sources for verification or additional information and to exchange information contained in or otherwise used regarding my application and participation in LIHEAP/IHWAP. I also authorize the Department of Commerce & Economic Opportunity and my utility/fuel supplier to share my usage and bill information during the twenty-four (24) month period prior to and twelve (12) month period after the date of my application submittal and/or completion of LIHEAP and IHWAP services for the purpose of program evaluation and analysis. I have received information outlining my appeal rights. I understand that filling out this application does not guarantee that my household will receive assistance. The purpose of this document is to provide a summary of the application to the customer for future reference. Improper documentation will delay your application being approved.


Here is the link for the appeal rights: https://liheap.ilenergyassistance.com/prod/liheap/forms/Appeal Rights-English.pdf

Appeal Contact Person:
Cathy Willis
Chief Financial Officer
711 W. McBean St.
Peoria, IL 61605
309.671.3900 EXT 238





Contact us

711 W. McBean St.
Peoria, IL 61605

Tel: (309) 671-3900

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