A completed payment assistance application consists of the following sections:

  1. Program/Payment/Intake (page 2)
  2. Mailing Address (page 3)
  3. Place of Service Address (page 4)
  4. Household Demographics (page 4)
  5. Electricity Account (page 8)
  6. Natural Gas Account (page 9)
  7. Wood/Propane/Oil Account (page 11)
  8. Additional Energy Accounts (page 12)
  9. Household Income (page 13)
  10. Performance Measures (page 15)
  11. Referrals (page 16)
  12. Rejections (page 17)
  13. Notes (page 18)
  14. Commitments (also known as pledges) (page 18)
  15. Recertifications (page 19)
  16. Files (page 20)
  17. CORE Status History (page 22)
  18. Monitoring Contacts (page 23)
  19. Audit/Change History (page 23)
  20. Energy Account Change History (page 24)


See the guide below for a detailed explanation of each section.