Cap Berkshire

    LIHEAP Forms

LOW-INCOME / NO INCOME INTERVIEW FORM   (For use in cases of “no income” or when monthly income is equal to or less than $200.00 after housing costs are deducted.)  All sections of this form MUST be completed by applicant.)


0 Income Form   Each adult (ages 18+) household member reporting no income (zero income) is required to complete a section below.