Form 2824-EL "Application for Assistance (Vision Impaired) - Energy Assistance Program" - Nevada

What Is Form 2824-EL?

This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Nevada Department of Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form 2824-EL by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.

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Download Form 2824-EL "Application for Assistance (Vision Impaired) - Energy Assistance Program" - Nevada

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IMPORTANT NOTICE
How to Apply for the Energy Assistance Program (EAP)
Submit a completed application (to include the name, date of birth and Social Security Numbers
for EVERY PERSON who lives in your home) with the following verification:
Proof of identity for the head of household (such as a driver’s license, government issued
1.
I.D., school I.D., etc.) and;
2.
Proof of citizenship or legal status if born outside of the United States and;
3.
Proof of where you live:
a. Provide a complete copy of your rental/lease agreement (listing all persons in your
home) and the signature page, or
b. a copy of your mortgage statement and;
4.
Provide a copy of most recent heating/cooling bills and;
When the utility bill is not in the applicant’s name, proof of identity for the individual
5.
listed on the utility bill is required along with written authorization for the applicant
to
apply, that includes their address, phone number and signature and;
6.
Proof of ALL income for EVERY PERSON in the household for at least the last thirty
(30) days.
Examples of types of income: Employment, child support, social security, Veterans
benefits, retirement, public assistance, utility reimbursements, unemployment
insurance, interest income, money from family and/or friends, or organizations,
educational scholarships and/or grants, etc.
Note: If the employed individual is working through an employment agency, provide
proof of the last 12 months of earned income.
7.
If the household expenses exceed the household income, proof of how the household is
meeting their needs.
**FAILURE TO PROVIDE THIS INFORMATION MAY DELAY THE
PROCESSING OF YOUR APPLICATION. **
Prior year recipients may not reapply until approximately 11 months after they received their last benefit.
Applications are processed in the order in which they are received. Applicants will receive a notice of
decision once an eligibility determination has been made.
or
Please mail
fax your application and verifications to:
Energy Assistance Program
Energy Assistance Program
2527 N. Carson St., #260
3330 E. Flamingo Rd., #55
Carson City, NV 89706
Las Vegas, NV 89121
Fax: (775) 684-0740
Fax: (702) 486-1441
7/18
IMPORTANT NOTICE
How to Apply for the Energy Assistance Program (EAP)
Submit a completed application (to include the name, date of birth and Social Security Numbers
for EVERY PERSON who lives in your home) with the following verification:
Proof of identity for the head of household (such as a driver’s license, government issued
1.
I.D., school I.D., etc.) and;
2.
Proof of citizenship or legal status if born outside of the United States and;
3.
Proof of where you live:
a. Provide a complete copy of your rental/lease agreement (listing all persons in your
home) and the signature page, or
b. a copy of your mortgage statement and;
4.
Provide a copy of most recent heating/cooling bills and;
When the utility bill is not in the applicant’s name, proof of identity for the individual
5.
listed on the utility bill is required along with written authorization for the applicant
to
apply, that includes their address, phone number and signature and;
6.
Proof of ALL income for EVERY PERSON in the household for at least the last thirty
(30) days.
Examples of types of income: Employment, child support, social security, Veterans
benefits, retirement, public assistance, utility reimbursements, unemployment
insurance, interest income, money from family and/or friends, or organizations,
educational scholarships and/or grants, etc.
Note: If the employed individual is working through an employment agency, provide
proof of the last 12 months of earned income.
7.
If the household expenses exceed the household income, proof of how the household is
meeting their needs.
**FAILURE TO PROVIDE THIS INFORMATION MAY DELAY THE
PROCESSING OF YOUR APPLICATION. **
Prior year recipients may not reapply until approximately 11 months after they received their last benefit.
Applications are processed in the order in which they are received. Applicants will receive a notice of
decision once an eligibility determination has been made.
or
Please mail
fax your application and verifications to:
Energy Assistance Program
Energy Assistance Program
2527 N. Carson St., #260
3330 E. Flamingo Rd., #55
Carson City, NV 89706
Las Vegas, NV 89121
Fax: (775) 684-0740
Fax: (702) 486-1441
7/18
Division of Welfare and Supportive Services
ENERGY ASSISTANCE APPLICATION
The Energy Assistance Program (EAP) is designed to help eligible Nevada
households with their annual heating and electric costs.
 INCOME REQUIREMENTS 
The total gross monthly income of all household members may not exceed the
amounts shown in the chart below.
YOUR HOUSEHOLD’S GROSS MONTHLY INCOME MAY NOT EXCEED:
Persons in
Annual
Monthly
Persons in
Annual
Monthly
Home
Income
Income
Home
Income
Income
1
$18,210
$1,517.50
5
$44,130
$3,677.50
2
$24,690
$2,057.50
6
$50,610
$4,217.50
3
$31,170
$2,597.50
7
$57,090
$4,757.50
4
$37,650
$3,137.50
8
$63,570
$5,297.50
(For families/households with more than 8 persons, add $6,480 for each additional person).
Households with a chronic or long-term illness, who pay out of pocket medical
expenses and whose gross income exceeds the income guidelines, may have their
countable income reduced by verified qualifying expenses.
(Page A) 2824 – EL (7/18)
BENEFITS
Eligible households receive an annual one-time per year benefit called a “fixed annual
credit” customarily paid directly to their energy provider(s). The benefit shows as a
credit on the bill.
MINIMUM PAYMENT –The minimum yearly payment for eligible households is
$180.
WHEN TO APPLY
 If your family is not currently on the program and you meet the income
requirements, apply NOW.
 If you received a benefit during the past 12 months, a notice will be mailed to you
when it is time to reapply. If you submit an application prior to the date you’re
eligible to reapply, the application will be denied.
? 
WHAT DO I NEED
Submit a completed an EAP application with the required documentation.
Suggested income
verifications are noted on the back of this page. To get answers to other questions, call:
Reno/Carson City (775) 684-0730
Las Vegas
(702) 486-1404
Toll Free
(800) 992-0900
Visit our website at: http://dwss.nv.gov for more information on the program
requirements.
(Page A) 2824 – EL (7/18)
DOCUMENTATION EXAMPLES OF REQUIRED PROOF OF INCOME
All documentation sent with your application can be either originals or photocopies. If you
are unable to photocopy the originals, our office will copy the material and if requested,
we will send it back after your case has been processed.
Earned Income: Includes income from employment, self-employment (see below), child
care services, house cleaning, and any service for which you are paid. Provide copies of
check stubs (if paid in cash, a statement from the person who paid you for a service) for at
least the last thirty (30) consecutive days. If paid weekly – 4 check stubs; paid bi-weekly
or semi-monthly – 2 check stubs. If you do not have check stubs, a signed and dated
statement of letterhead from your employer stating your gross income for the last thirty
(30) days and how often your get paid, is acceptable. If working through an employment
agency or on-call provide proof of the last 12 months of income.
Self-Employment/Non-Profit Business Income:
May include profit and loss
statements signed by the applicant detailing gross income and expenses (receipts must
be provided for deductions) during the last 12 months, a copy of the sales tax statement
showing gross net proceeds, financial statements, a loan application listing income and
expenses for the last 12 months, or DWSS Form 2011 that includes receipts for
allowable deductions. Allowable deductions include: cost of goods sold, supplies and
materials, advertising, accounting and legal fees, wages paid to employees, office
space rent/mortgage, telephone, utilities, transportation costs necessary to produce
income, etc.
(Page B) 2824 – EL (7/18)
Unearned Income: Includes income from Social Security Administration, Veterans
Administration, pensions, disability, military service, unemployment, child support,
alimony, interest, dividends, regular insurance or annuity payments. If you are receiving
Social Security, SSI, Veterans Benefits, pensions, disability income, military income
or unemployment: provide copies of the benefit verification form or award letter for the
current year showing any cost of living raises.
If you are receiving child
support/alimony income: provide a copy of divorce decree/separation/settlement
agreement or dated letter from the person paying the support (to include name, address and
phone number), or a copy of the last check/statement from the child support enforcement
agency. If you are receiving interest income/dividends: provide 12 months of bank
account statements, certificates of deposit or other documentation that contains details and
is signed by the financial institution, or a broker’s quarterly statement showing earnings.
Cash Contributions and/ or Recurring Gifts: If someone is helping you pay your
expenses or is giving you money: provide a signed statement from each person that
includes their name, address, phone number, if the assistance will continue, and the
amount provided to you during the last six months. Provide a signed and dated statement
by the person providing the money indicating the amount of support, how often it is paid,
when the arrangement began, and whether it is paid directly to a vendor or in cash to
you. The statement must include the contributor’s printed name, address(es), and phone
number(s).
(Page B) 2824 – EL (7/18)