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					                         ENERGY ASSISTANCE PROGRAM
                               PROCEDURES MANUAL
                            REVISED:        OCTOBER, 2002


BACK                            CONTENTS                              FORWARD


III.   APPLICATION PROCESSING - FORM #6000

       A.   PURPOSE

            *All persons have a right to apply for assistance and must be given the opportunity
            to make an application. If not eligible, denial procedures should take place.

            1.     The EAP Application Form #6000 (Attachment III-2) allows for the
                   collection of specific information necessary to identify households who are
                   eligible for Low-Income Home Energy Assistance Program benefits. The
                   EAP application also allows for the collection of minimal reporting data to
                   assure accountability of program objectives.

            2.     The EAP application is to be completed only by a temporary, permanent or
                   volunteer staff member or worker who has completed a local training session
                   on EAP application processing.

            *Note - All applications accepted by the LAA for employees of the agency must
            be completed by the EAP Coordinator and signed by the agency director (or
            designee).

                   Information used to complete the EAP application will be obtained from the
                   applicant, current agency records and additional verification documents.

            3.     The trained staff person will enter the data on the EAP application as
                   questions are asked of the applicant.




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                        ENERGY ASSISTANCE PROGRAM
                                 PROCEDURES MANUAL
                             REVISED:       OCTOBER, 2002

B.   General Instructions
                  1.        Applicant Authorization
                            a)    Every applicant must
                                  1) be a member of the household requesting assistance,
                                  2) provide all the necessary information to complete the
                                     application form,
                                  3) sign the application in the presence of the worker as
                                     provided for in Item 3O of the EAP application.
                            b)     The signature in Item 30 must be the same as the applicant
                                    name in Item 4, unless covered by the exception below:
                  * The only exception to the applicant signature requirement is 1) if an
                  applicant is homebound and the local agency is unable to send an intake
                  worker to the applicant's home or the applicant is unable to apply in person
                  due to unusual circumstances. In each situation the applicant may authorize
                  someone else to file an application on his behalf. Such authorization must be
                  in writing and signed by the applicant. The applicant must provide
                  information to complete the application including the Social Security
                  Numbers of all members of the household with income and proof of total
                  gross household income. In this case, the person giving the information to
                  the worker will sign his/her own name in Item 30. The applicant's signed
                  authorization will be attached to the file copy of the application.
                  Note - If no adult is able to come in, a child under age 18, may not apply.
                  (Also see Authorization Representative, Chapter III, page 14)
                  Note - If the County DFCS is legal guardian, (i.e. APS referral), the
                  application may be signed on behalf of their ward without supporting
                  documents. In other instances supporting documentation should be attached.

                            c)      Illegal aliens and aliens admitted under Section 245A and
                            210A of the Immigration and Naturalization Act are not eligible for
                            Energy Assistance benefits. However, other household members may
                            be eligible. Ineligible aliens will not be counted in determining
                            household size; their income will be considered in calculating the
                            household's projected total annual gross income (see Section IV).
                                            III-2
                ENERGY ASSISTANCE PROGRAM
                      PROCEDURES MANUAL
                    REVISED:       OCTOBER, 2002


2.         Appointment Schedule/Intake Log

           (Regular Program only) In order for clients to be served in a timely manner,
           it is recommended that LAA's establish and maintain an appointment
           schedule system. The log should track an application from the point at which
           the client contacted the agency to schedule an appointment to issuance or
           denial of benefits. Intake logs are also to be maintained by LAA's for the
           homebound application process. Every effort should be made to ensure that
           clients are served on a first-come basis. Clients may be screened through
           telephone calls, informed of the information necessary for application
           (income verification, personal identification, etc.) and be given an
            appointment for application.


                  All LAA's will maintain some form of intake log for proper tracking
                  of applications. Basic information to be gathered may include:
                  Worker's name, client's appointment time, date, name and telephone
                  number, income source, Social Security number, time and date client
                  was seen, and application disposition. Appointments should be
                  scheduled so that adequate time is allotted for recording information
                  and pulling files should the applicant be an SS, SSI, TANF, or FS
                  recipient. Specific information is left to the discretion of the LAA.

     3.    Non-English Speaking Applicants

                  Non-English Speaking Populations – In areas where persons with
                  Limited English proficiency reside, the LAA will provide outreach
                  information in languages specific to those persons. Resources for the
                  development of these materials should include bilingual agency staff,
                  contracted interpreter services, community volunteers, and ethnic
                  organizations.    Agencies must ensure that Limited English
                  Proficiency (LEP) persons have meaningful and equal access to all
                  benefits and services.

C.   Forwarding of EAP Form 6000 (Rev. 11-91)

     1.    Regular Energy Assistance Application

           a.     Approved Applications - Should be forwarded to Community Action
                  Agency Central Office for data entry and processing.

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                              PROCEDURES MANUAL
                           REVISED:        OCTOBER, 2002


           *Data entry of approved applications should occur within ten (10) work days
           after the LAA's approved signature date. Checks should be issued for approved
           applications within ten (10) work days after the approved transaction report is
           received. This will ensure timely receipt of credit on the applicant's utility bill
           within thirty (30) days of the application date.

                  b.      Disapproved applications - Data entry of denied applications will be
                          conducted locally at the appointed time as determined by CSS.
                          Disapproved applications will be maintained by the agency's central
                          office in an alphabetical file.

D.   Detailed Instructions for EAP Application Form 6000 Completion

           Items as detailed below must be completed by either entering data or checking a
           block on the form. Where data is entered, it must be printed in block letters, one
           letter per block, up to the maximum number of blocks per item provided on the form.
            No items on the form may be left blank except as indicated in the detailed
           instructions.

           l.     Agency - Enter the three character code number assigned to your agency. A
                  list of agency codes and contracting agencies is included on Attachment 5.
                  All three digits must be entered (For example, the proper code for ACTION,
                  Inc. is 303)

           2.     Social Security Number - Enter the applicant's nine digit Social Security
                  number. Any letters following the Social Security number are to be added
                  outside the boxes. Every effort should be made to obtain the applicant's
                  correct Social Security number. A copy of the documentation must be
                  included with the application. The Social Security number is to be verified
                  from an original Social Security Card, Social Security Grant Award Letter,
                  check stub with name or other official documentation. If the applicant
                  does not have a Social Security number, a pseudo (assigned) number must be
                  entered. Assigned numbers will be controlled by the local agency. Numbers
                  for contract agencies will consist of the agency code followed by a six digit
                  sequential number starting with one (1) (for example, 305-00-0001). A
                  master list of all assigned numbers containing the name and mailing address
                  of the applicant to whom each number was assigned must be maintained by
                  the local agency. A neighborhood service center needing a pseudo number
                  may be assigned a block of numbers from the master list for that agency.


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           ENERGY ASSISTANCE PROGRAM
                 PROCEDURES MANUAL
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3.   County Code - Enter the county code for the county in which this applicant
     lives. This code must be entered as three digits. For example, Bacon County
     would be entered as 003. See Attachment 5 for proper codes.

4.   Name - Enter the Name of the applicant as first name, middle initial, last
     name, skipping a space between each name or initial.
     Example:
     |J|O|H|N| |F| |S|M|I|T|H|

5.   Address Information - Residential service address information should be
     verified from case records, fuel/utility bill or other written documentation.
     Ask applicant for this information before filling out this section.

     Rural Route - If the applicant lives on a rural postal route, enter the number
     as two digits, for example |0|1|. Otherwise, leave the space blank. Only
     include the numbers. Do not include any word abbreviations.

     Box Number - If the applicant receives his/her mail in a numbered rural
     delivery mailbox, enter the box number starting in the first space provided
     and enter as many numbers as required up to five. Otherwise, leave these
     spaces blank.
     Example:
     |3|2|2| | |
     Box No.

     P.O. Box - If the applicant receives his/her mail at a post office box, enter the
     box number starting in the first space provided and enter as many numbers as
     required up to six. Only include numbers. Do not include any word
     abbreviations. Otherwise, leave the spaces blank.
     Example:
     |9|6|6|3| | | |
     P.O. Box

     Building Number - If the applicant has a building number, enter that number
     starting in the first space provided and enter as many characters as required
     up to five. This field may include letters and dashes if appropriate.
     Otherwise, leave these spaces blank.
     Example:
     |C|-|1|2| |
     Building No.

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                   PROCEDURES MANUAL
                REVISED:        OCTOBER, 2002


       Apartment Number - If the applicant has an apartment number, enter that
       number starting in the first space provided and enter as many characters as
       required up to five. This field may include letter and dashes if appropriate.
       Otherwise, leave the spaces blank.
       Example:
       |1|1|-|-|B|
       Apartment

6.     Street Number - Enter the street number of the applicant's residence. If there
       is no street number leave blank. Do not abbreviate number with the number
       sign (#). Enter numerals only. Example:
       |5|2|5| | |

       Street Name - Enter the street name of the applicant's residence.

       *Note: Do Not write the street name in the space designated for street
       number.

       Be as accurate as possible in correctly spelling the street name.

Acceptable abbreviations:                     Extension              |E|X|T|
                                              Street                 |S|T|
                                              Avenue                 |A|V|E
                                              Road                   |R|D
                                              Drive                  |D|R
                                              Boulevard              |B|L|V|D
                                              Lane                   |L|N
                                              Circle                 |C|I|R
                                              Court                  |C|T
                                              Building               |B|L|D|G
                                              Trailer Park           |T|R|P|K
                                              Trail                  |T|R|L
                                              Place                  |P|L
                                              Terrace                |T|E|R
                                              Creek                  |C|R|K
                                              North                  |N|
                                              South                  |S|
                                              East                   |E|
                                              West                   |W|


                               III-6
                    ENERGY ASSISTANCE PROGRAM
                           PROCEDURES MANUAL
                       REVISED:        OCTOBER, 2002


      Do not abbreviate:                      Park
                                              First
                                              Second
                                              Third, etc.

      Mobile Home Park is to be written as Trailer Park.
                                   |T|R|P|K

      Special Instructions

      If an applicant's residential address cannot be specified and the only address that can
      be obtained is General Delivery or Star Route, the words General Delivery or Star
      Route are to be placed in the space designated for street name.
      Example:
      Street No.       |G|E|N|E|R|A|L| |D|E|L|I|V|E|R|Y
                                              Street Name

7.    City - Enter the city where the Post Office serving this applicant is located.

8.    State - Enter the two character state abbreviation for the state in which the Post
      Office serving this applicant is located. The only abbreviations which can be used
      are:

             GA - Georgia                     TN - Tennessee

9.    Zip Code - Enter the five-digit zip code of the Post Office serving this applicant.
      Make every effort to enter this information in order to insure that payments are
      credited to service at the correct residential address.

      Phone Number - Enter phone number in the space provided. If the applicant does
      not have a home telephone, try to secure the telephone number of a relative or
      friend who has regular contact with the client.

l0.   Living Quarters - Enter the appropriate one digit number that applies to the
      household in the box(es) which best describe the living arrangements of this
      household as declared by the applicant.




                                      III-7
              ENERGY ASSISTANCE PROGRAM
                    PROCEDURES MANUAL
                  REVISED:        OCTOBER, 2002


Item #l - Other - Enter the number 1 in the front box if applicant is in an Ineligible
Living Arrangement.

a)      SSI recipients living in congregate care or domiciliary care facilities or foster
        care placements who receive SSI state supplements which correspond to
        these living arrangements;

b)      Applicants who live in other public or private institutions whose living costs
        are subsidized by state or local governments, i.e. residents of vocational
        facilities whose living costs are subsidized, persons in nursing homes or
        medical institutions;

c)      Applicants who live in group living facilities/quarters, i.e. rooming and
        boarding houses, hotels, institutions, workers dormitories, communes,
        military barracks, college dormitories, missions, flophouses and shelters,
        monasteries, sorority or fraternity houses, inmate facilities, or other quarters.

        Item #2 - Enter the number in the first box if applicant is in subsidized
        housing. An applicant in subsidized housing will have two numbers in the
        boxes, i.e. 2+ 3, 2+4, or 2+5. (If 2+5 is entered, the household is not eligible
        for assistance)(This is a list of the most common subsidized housing)

        Single or multi-family structures that are constructed or managed in part or in
        whole by monies from the following sources:

-       Section 22l(b)(3) of the National Housing Act of l968 (12 USC l7l5l)

-       Section 236 of the National Housing Act of l968 (12 USC l7l5z-1)

-       Section 202 of the Housing Act of l959 (12 USC l707)

-       Housing Act of l947 (42 USC l473l) (Section 8 Housing)

-       Section 315 of the Housing Act of 1949 (USC 1485)

Items #3-5 - Enter the number 3, 4, or 5 in the appropriate block to indicate how the
fuel costs are paid. If the applicant is not in subsidized housing, the numbers, 3, 4, or
5 will be entered in the first box.



                                 III-8
                    ENERGY ASSISTANCE PROGRAM
                          PROCEDURES MANUAL
                        REVISED:        OCTOBER, 2002


      Special Instructions

      *If household does not pay rent or own its home, but does pay it's primary heating
      fuel/utility, enter the number 4 in the appropriate box.

      If #5 is entered in the box (Rent includes utilities) the household is eligible to
      receive benefits from this program.

      *If the household resides in subsidized housing and the rent includes utilities , the
       household is NOT eligible to receive benefits from this program.

      THE HUD AREA OFFICES HAVE ADVISED US THAT ALL HUD-SUBSIDIZED
      HIGH-RISE TENEMENT DWELLINGS HAVE NO FUEL COSTS IN THE
      RENTAL PAYMENT CHARGED TO RESIDENTS. ARE THESE RESIDENTS
      ELIGIBLE FOR EAP?

      NO. ALTHOUGH THEY MAY MEET THE INCOME CRITERIA FOR EAP,
      THEY DO NOT HAVE ANY RESPONSIBILITY FOR FUEL COSTS AND
      ARE, THEREFORE, INELIGIBLE FOR THE REGULAR AND EMERGENCY
      PROGRAMS.

      10A.    Leave this Section blank.

11.   Are Any Members of the Household Receiving Benefits From:

      If any member of this household is receiving benefits from one of the sources listed
      below, enter appropriate numbers in the boxes |l|2|3|4|. It is possible for all or none of
      the boxes to be completed. The four benefit sources are defined as follows:

      l)      Supplemental Security Income (SSI) benefits under Title XVI of the Social
              Security Act;

      2)      TANF (other than TANF Foster Care or Emergency Assistance to Needy
              Families with Children);

      3)      Food Stamps under the Stamp Act if l977;

      4)      Veterans Benefits under Sections 415, 521, 541, or 542 or Title 38 of the U.S.
              Code or Section 306 of the Veterans and Survivors Pension Improvement Act
              of l978. Payments under these sections are considered pensions as opposed
              to other veteran's payments which are considered compensation.
ENERGY ASSISTANCE PROGRAM
   PROCEDURES MANUAL
  REVISED:   OCTOBER, 2002


                 III-9
                    ENERGY ASSISTANCE PROGRAM
                          PROCEDURES MANUAL
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12.   Primary Source of Income - Enter in the box the single digit that best describes the
      household's primary source of yearly income. Primary means the largest single
      source of income for the entire household, even though that source may not be the
      largest source for any one member of the household.

      EXAMPLE: If member A has wages of $3,000 and SSI benefits of $2,500 and
      member B has wages of $l,000, then total wages for the household are $3,000, the
      number (1) wage should be entered in the box as the primary source of income for the
      household - not the number (3) for SSI. If Number (9) is entered, specify income
      source in space provided - such as contributions.

FOR REPORTING PURPOSES

13.   Age - Enter the age of the applicant as two digits.

      *Example: If the applicant is 47 years old, enter
       |0|4|7|.

l4.   Sex: - Enter the appropriate letter M or F to indicate whether the applicant is male or
      female.

15.   Number of Elderly in Household - Enter the number of people 60 years or older,
      including the applicant, living in the household. If none, enter 0, if more than nine,
      enter a 9.

16.   Number of Disabled in Household - Enter the number of disabled people living in the
      household. If none, enter a 0; if more than nine, enter a 9. For this program, disabled
      is defined as:

      "An individual who has either a physical or mental impairment that substantially
      limits one or more major life activities; a person who has a history of such a
      condition; a person who is regarded as having such a condition, or a person eligible
      for Vocational Rehabilitation Services".

      "Major life activities" mean functions such as caring for one's self, performing
      manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.
      Physically challenging conditions include, but are not limited to:

                                      III-10
                    ENERGY ASSISTANCE PROGRAM
                          PROCEDURES MANUAL
                       REVISED:        OCTOBER, 2002


       Acquired Immune Deficiency Syndrome (AIDS)
       *Alcoholism
       Cancer
       Cerebral Palsy
       Deafness or Hearing Impairments
       Diabetes
       *Drug Addiction
       Epilepsy
       Heart Disease
       Mental or Emotional Illness
       Mental Retardation
       Multiple Sclerosis
       Muscular Dystrophy
       Orthopedic, Speech or Visual Impairment
       Perceptual Handicaps such as:

              Dyslexia
              Minimal Brain Dysfunction
              Developmental Aphasia

*The U.S. Attorney General has ruled that alcoholism and drug addiction are physical or
mental impairments that are handicapping conditions if they limit one or more of life's
major activities.

17.    Total Number of Children in Household:

       a)     Zero to Two (0-2) - Enter the number of children living in the household
              who, on the date of application, have not reached their third (3rd) birthday.


       b)     Three to Five (3-5) - Enter the number of children living in the household
              who, on the date of application, have reached their third (3rd) birthday, but
              have not reached their sixth (6th) birthday.

       c)     Six to Twenty (6-20) - Enter the number of children living in the household
              who, on the date of application, have reached their sixth (6th) birthday, but
              have not reached their twenty-first (21st) birthday. If none, enter 0, if more
              than nine, enter 9



                                      III-11
                     ENERGY ASSISTANCE PROGRAM
                           PROCEDURES MANUAL
                        REVISED:        OCTOBER, 2002


18.    Is any Member of Household Homebound? - Enter the appropriate letter to answer
       yes or no. For this program, homebound is defined as "a person who, in the
       judgement of the LAA, is deemed unable to travel to an LAA to apply for energy
       assistance because of a medical condition which currently qualifies the person
       through Medicaid or Medicare for home services, and/or currently receives Meals-
       On-Wheels, home-health agency services, or homemaker services through DFCS, or
       has disabilities confining the person to the home". No written verification is required
       to identify a homebound situation.

       *A disabled person is not necessarily homebound.

19.    Referral to Weatherization – Enter the appropriate letter to answer yes or no.
       A weatherization referral form must be completed for all eligible LIHEAP recipients
       who have not already received services.

20.    For which energy source is assistance being provided? - For the Regular Winter
       Program, enter the single number which indicates which fuel is used most by this
       household for heating. Ask to see a copy of the household's heating fuel bill to
       properly identify the primary heating source.

21.    Number of People in Household - Enter the number of people living in the household
       as identified on the corresponding Income Worksheet as two digits. For example, a
       single-person household would be entered as 0l. For this program, a household is
       defined as any individual or group of individuals who are living together as one
       economic unit for whom residential energy is customarily purchased in common.

       *Note: Ineligible aliens are not counted in determining the household size.

22.    Annual Income - From the Income Worksheet, enter here the total annual income for
       entire household.

       Example: $5,085 annual income = |0|5|0|8|5|

       *Note - Income of ineligible aliens is counted in determining the household's
       projected total gross annual income.


22a.   Pure Public Assistance HH – Enter the appropriate letter to answer yes or no.
       (refer to I-9, #16)

23.    Monthly Income - From the Income Worksheet, enter here the total monthly income
       for the entire household.
ENERGY ASSISTANCE PROGRAM
   PROCEDURES MANUAL
  REVISED:    OCTOBER, 2002

             III-12
                    ENERGY ASSISTANCE PROGRAM
                          PROCEDURES MANUAL
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24.   Income Level - Using the Income Worksheet information and the Income Level
      Chart, enter here the one digit income level according to household size and gross
      income code to be used in calculating the amount of assistance to be provided to this
      household.

25.   Energy Crisis Intervention Authorization - Leave blank. Do not write 0, N/A, or any
      other notation.

26.   Emergency Authorization - Leave blank for Regular Energy Assistance Program.

27.   Amount of Assistance Authorized - From the appropriate Payment Assistance
      Schedule, enter the amount of assistance for which this household is authorized.
      If the amount of assistance for which this household is authorized. If the amount of
      assistance authorized is less than $l00, enter a "0" on the first space.
      Example:
      |0|8|1|

28.   Vendor Code - If the applicant uses as a primary home heating source a supplier, who
      has signed a Home Energy Supplier's Agreement with the Energy Assistance
      Program, enter the three-digit code which identifies that Home Energy Supplier on
      the approved Vendor List. If this applicant uses home energy supplier has not signed
      an agreement and is not in the Vendor Book, enter |9|9|9|.

      *Note - Most of the large fuel suppliers in Georgia have signed agreements. These
      include LP Gas Dealers, EMC's, Coal Dealers, Natural Gas Marketers, Georgia
      Power, etc.

29.   Account Number or Name - The Approved Home Energy Suppliers Vendor List will
      indicate whether this home energy supplier uses account numbers or names to
      properly identify accounts. If the home energy supplier uses account numbers, enter
      the proper account number for this household first, then the last name of the person in
      whose name the account appears. This can be taken from a bill or stub furnished by
      the applicant. If the vendor uses names, or if the Vendor Code is 999, enter the name
      under which the account is listed by the vendor (last name first, first name, and
      middle initial). A copy of the utility bill must be included with the application.



                                      III-13
                    ENERGY ASSISTANCE PROGRAM
                          PROCEDURES MANUAL
                       REVISED:        OCTOBER, 2002


30.   Vendor Name - Enter the proper name of the applicant's
      home energy supplier exactly as it is listed on the Approved Home Energy Suppliers
      Vendor List. (Enter the name of the applicant if the home energy supplier is not
      listed on the Approved Home Energy Suppliers Vendor List)

31.   Applicant's Signature - The applicant must read or have read to him/her this section
      and must sign the application in the space provided. If the applicant cannot write,
      have the applicant make an "X", then the worker must write in the name of the
      applicant. The caseworker's signature in Item 33 is that of the worker who witnesses
      the signature of the applicant.

      A copy of the six declarations of application Item 30 is printed in large type
      (Attachment III-4). A copy of this attachment is to be provided to applicants who
      might experience difficulty in reading those declarations as printed on the application
      form itself.

      Authorized Representative

      The authorized representative must have written authorization from the household
      for which he/she is making application. A copy of the authorization is to be attached
      to the white copy of Form #6000.

      -      The authorized representative must be eighteen (18) years of age in order to
             apply on behalf of the household. Persons under age eighteen (18) cannot
             sign a legally binding agreement.

      -      The authorized representative will sign his/her name, not the applicant's
             name. The Legal Guardian of a person may sign the application on behalf of
             their wards without supporting documents if the County Director is guardian.
              In other instances supporting documentation should be attached.

      -      The worker must be sure that the applicant or authorized representative reads
             or is read and understands the six declarations in Item 30 before the
             application is signed. If the applicant cannot read, the worker must read the
             declarations to the applicant.
ENERGY ASSISTANCE PROGRAM
   PROCEDURES MANUAL
  REVISED:    OCTOBER, 2002

             III-14
                    ENERGY ASSISTANCE PROGRAM
                          PROCEDURES MANUAL
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32.    Approved - If this application is approved, enter an X in the box.

       -      Direct Vendor Payment

              If the household pays directly to the vendor and the vendor is on the vendor
              list, enter an "X" in the box. The check will be issued directly to the energy
              supplier by the LAA.

       -      Payment to Applicant

              If the household pays directly to the vendor and the vendor is not on the
              vendor list, enter an "X" in the box. The check will be a direct payment in
              the name of the applicant.

       -      Date Regular Check Issued

              Enter the 6-digit date the check is issued, month, date, year, i.e. 06-07-00.
              This is completed after the check is issued. Leave blank for the emergency
              program.


33.    Disapproved - If the household is determined to be ineligible for assistance, check
       this box and enter the reason for the denial on the line provided.

       Comments - Make any desired comments pertinent to this application or applicant.

*NOTE - With a ball point pen boldly write "Denied" across the      face of the application.

34.    Signature of Worker(s) - All workers who assisted the applicant must sign the
       application in ink in the space provided. Do Not use signature stamps.




                                      III-15
                          ENERGY ASSISTANCE PROGRAM
                                PROCEDURES MANUAL
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     35.    Application Date - Enter the date on which this application is taken as six digits in
            month, day, year sequence. Example: If the application is being completed on
            January l2, 2000, the application would be entered |0|1|-|1|2|-|0|0|. When a pending
            application is taken, enter the date pending information is received below the
            application date.

     36.    Local Agency Authorized Signature - Every application,
            whether approved or disapproved, must be signed by the person authorized to sign for
            the local agency. (See Special Instructions outlined in Section III-G.) The LAA
            Signature must be different from that of the worker in Item 34. Do not use signature
            stamps or sign in pencil.

     37.    Date Authorized - Enter the date on which this application is signed by the LAA as
            six digits in month, date, year sequence. Example: |0|1|-|1|4|-|00|


     38.    Date keyed - This item is to be filled in by the Data Entry Operator (DEO) at the
            time of data entry into the EAP System.

E.   Distribution Process for EAP Application for the Regular Program

     1.     Original first copy (white copy) is the payment copy and remains in the central office
            of the agency which issued the benefit check. The Income Worksheet and all
            verification documents are attached to this copy.

     2.     Second copy (yellow copy) is the client copy when the application is denied. The
            copy is given to or sent to the client after the reason for denial has been entered in the
            comment section, and the application has been signed by the worker.

     *Denied applications should be reviewed by the EAP Coordinator before this process
     occurs.

     3.     Third copy (pink copy) is the client's copy and must be provided to the applicant only
            after the application has been approved and signed by the local agency authorizing
            official, processed through the computer and appears on the Approved Transaction
            report. The applicant may request that the "pink copy" be sent to the household or
            the applicant may pick up the "pink copy" following final approval of the application.
             If the "pink copy" is mailed to the applicant, it can be folded and mailed in a
            standard #l0 envelope.


                                             III-16
                          ENERGY ASSISTANCE PROGRAM
                                PROCEDURES MANUAL
                             REVISED:        OCTOBER, 2002


            MAY THE LOCAL AUTHORIZING AGENCY (LAA), AT THE CLIENT'S
            REQUEST, SEND THE PINK COPY OF FORM #6000 DIRECTLY TO THE
            VENDOR?
            The pink copy of Form #6000 is the client's official notice of approval. The agency
            should not send the pink copy of Form #6000 directly to the vendor without the
            WRITTEN specific authorization of the client after the applications are computer
            processed and the names appear on the Approved Transaction repost.
            All approved clients must receive the "pink copy".
F.   Information Notice Form
     Give the applicant an information Notice Form #6004 and explain the type of check that the
     applicant will receive.
G.   Local Authorizing Authority
     1.     Local Authorizing Authority can be granted by the designated contract agency
            Director to one or more persons. This authority can be granted to responsible
            personnel who oversee the work performance of workers taking and certifying EAP
            applications. This designation must be in writing and must be on file in the LAA.
            Copies must be sent to the State office.
     2.     Before authorizing each application the Local Authorizing Authority is responsible
            for reviewing the EAP applications to assure all Items have been completed.
            a.      All fields on the application Form #6000 are critical and must be completed
                    correctly.
            b.      If the Applicant Name (Item #4) is not the same as Applicant's Signature
                    (Item #30), then written authorization must be attached to the original copy of
                    the EAP application.
            c.      The Income Worksheet should be reviewed to assure calculations are correct
                    and adequate verification or documentation is attached.
            d.      Available Benefit Allocation Funds should be reduced by the amount of the
                    Assistance Authorization (Item #26), manually at the local office. Official
                    tracking of funds is done by the EAP subsystem.
            The application should be maintained in date and time order to the extent possible.



                                            III-17
     ENERGY ASSISTANCE PROGRAM
          PROCEDURES MANUAL
       REVISED:           OCTOBER, 2002


               ATTACHMENTS

1.    Intake/Appointment Log

2.    EAP Application Form 6000 (Rev. 09/00)
      Spanish Translation (forthcoming)

3.    Applicant Signature Section Reprint

4.    Agency/County Codes

5.    Information Notice

6.    Alien Eligibility

7.    Translator Information




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