PY2026 LIHEAP

Welcome to Project NOW's Pre-Screening Eligibility for LIHEAP Assistance.

Please note that completing this form does not guarantee assistance. All eligibility factors will need to be reviewed to determine approval for assistance.

To serve your request in a timely manner, please have your household's Social Security numbers, 30 day income details, and utility bills readily available to upload throughout this application. Allow up to 30 days for the review of your application. If you are at risk of disconnection, we strongly recommend contacting one of our offices directly to schedule an appointment with an intake worker to avoid any delays in processing.

It is important to provide the most accurate contact information during this application, as we may need to follow up with you regarding the information you provide.

Note: To save your progress, click Save at the bottom of the page. You will receive an email with a link to return to your application at any time.

Address and Dwelling Information
Address*

Home Address (Physical)

Street Address Line 2

CityState

Zip
Mailing Address (If different than physical address, please)

Mailing Address (if different than physical)

Street Address Line 2

CityState

Zip
Telephone Number (include area code)*
Alternate Telephone Number (include area code)
4.Dwelling Information: (What kind of dwelling do you live in?)*

Single Family HouseMobile HomeApartment 2-4 UnitsApartment 5+ Units
Do you rent?*
Is your rent subsidized?*
Rent amount?*
Is your heat included in your rent?*

Tell Us About Your Utility Providers
How do you heat your home?

Natural GasPropaneElectricWoodI do not pay for my heat.
What percent do you currently have in your tank?
Please provide us the name of your Primary Heating Vendor
Example: MidAmerican, Ameren, Blick & Blick, Gold Star, etc.
Primary Utility Account Number
Please provide us the name as it shown on your Primary Bill.

First NameLast Name
Do you currently have a Disconnection Notice from your heating source? *
If disconnected from your heat source, do you have alternate shelter, or a safe temporary heat source (space heaters)?*
Do you currently pay for Secondary Electric*
Non-heat related electricity
Please provide us the name of your Secondary Utility Vendor
Secondary Electric Vendor (lights)
Secondary Utility Account Number
Please provide us the name as it shown on your Secondary Bill.

First NameLast Name
Please Upload a copy of your utility bill(s)*

Cancelof
How do you cool your home? *
How many window units do you have? *
Where are your window units located? *
How many bedrooms do you have? *

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 RQUIRED. Failure to provide any information will result in this application not being processed.

APPLICANT STATEMENT: I certify that the information I have provided above is accurate and a complete disclosure of the requested information. I also certify that every household member in the application is either a US Citizen or an eligible Illinois resident regardless of immigration status according to the LIHEAP rules. I authorize this agency to verify the information and contact my utility/fuel supplier, landlord, employer and/or other sources for verification for additional information and to exchange information contained in or otherwise used regarding my application and participation in LIHEAP. I also authorize the Department of Commerce and 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 Weatherization services for the purpose of the 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 services.
Signature*

Clear
Date*

MonthDayYear
Date
Application Status

ApprovedDeniedToo early5 days hold for documents
Should be Empty:

Tell Us About Your Household

Address and Dwelling Information

Tell Us About Your Utility Providers

PLEASE READ AND SIGN