1 Start 2 Complete To be eligible, your household must already be receiving social service aid of some kind. Additionally, your household monthly gross income may not exceed the following: Household Size 12 Month 3 Month 1 Month 1 $39,101 $9,775.25 $3,258.42 2 $51,133 $12,783.25 $4,261.08 3 $63,164 $15,791.00 $5,263.67 4 $75,196 $18,799.00 $6,266.33 5 $87,227 $21,806.75 $7,268.92 6 $99,258 $24,814.50 $8,271.50 7 $101,514 $25,378.50 $8,459.50 8 $103,770 $25,942.50 $8,647.50 First Name: * Last Name * Middle Initial: * Street Address: * City/Town: * Zip Code: * Phone Number: * Email: * Do you own your home or rent? * OWN RENT Do you live in Section 8 or Subsidized Housing * Yes No Monthly Mortgage/Rent Amount * Are there any U.S. Veterans in the household? * Yes No List ALL household members' NAME and Date of Birth: * Where is your oil tank fill valve located on your property (front of house, back of house, side of house). * Upload Proof of Social Service Aid (photo of document of SSI, SNAP, WIC, LIHEAP, etc.) * Files must be less than 2 MB.Allowed file types: gif jpg jpeg png tif doc docx. By providing application information, you authorize the City of East Providence and its authorized agents to verify the data provided against federal, state, county, employer and landlord databases or records. I know that should any information I provide in this application be false or misleading, it will be the basis for ineligibility and will be investigated and prosecuted as fraud. I also acknowledge that my eligibility does not guarantee receipt of this one-time heating oil assistance, as all eligible applicants will be chosen on a first-come, first-serve basis. Electronic Signature: * Date of Signature: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20232024202520262027
