HEAP and Emergency HEAP
 Gross income for everyone in the home for most recent 13 weeks
 Social Security numbers of everyone in the home
 Birthdates of everyone in the home
 Medicaid or Healthy Start card in applicable
 Electric bill
 Gas bill
(*to qualify for emergency HEAP, a utility must be in disconnect status)

HWAP application
 Gross income for everyone in the home for the last 12 months
 Proof of home ownership or landlord form, if applicable
 Gas bill
 Electric bill
 Social Security numbers of everyone in the home
 Birthdates of everyone in the home
 Completed energy application
(*Households receiving SSI or TANF automatically qualify, regardless of income total)

Salvation Army
 Driver license of primary applicant
 Social Security Cards of everyone in the home
 Birth Certificates of everyone in the home
 Most recent check stub, if applicable
 Proof of other gross income for everyone in the home (Child support, SSI, TANF, Social Security, etc.)
 Medicaid or Healthy Start card, if applicable
 Medical appointment card and proof of vehicle insurance (if assistance is for fuel)
 Eviction notice (if assistance is for housing)

Mercer County CHIP
 Completed application packet
 Verification of income of all household members over the age of 18
 Declaration page of homeowner insurance policy
 Most recent statements of any financial accounts held
 Most recent utility bills
 Most recent federal income tax return
 Statement of assets held (stocks, bonds, annuity, etc.)
 Documentation of real estate owned
QUALIFICATIONS
AND
AVAILABILITY
OF ASSISTANCE
PROGRAMS MAY
VARY.

NOT ALL
FUNDING
SOURCES
AND
PROGRAMS
ARE LISTED.

PLEASE
CONTACT
OUR
OFFICE
TO
SEE
HOW
WE
MAY
HELP
YOU.
CONTACT
US AT
(419) 584-1550