Washington LIHEAP and state home energy assistance: Byrd Barr Place LIHEAP

• What is your preferred language?

  24 choices

• What is your primary language? · optional · if it applies

• Is this your first time applying for Energy Assistance?

  Yes · No

• How do you hear about Byrd Barr Place? · if it applies

  10 choices

• Please enter your email address. (full text under What you agree to)

• Please select your ZIP code

  27 choices

• What is your current heating situation? · if it applies

  I need help paying my heat bill · I have received a disconnect/urgent notice · My heat has been disconnected · I am out of oil/propane/wood

• First Name · if it applies

• Middle Name · optional · if it applies

• Last Name · if it applies

• Residential Street Address - Matching your utility bill - include APT # after typing/selecting *Please do not include Seattle or Washington * all clients must reside in Seattle Washington* (full text under What you agree to) · if it applies

• Residential ZIP Code · if it applies

• Do you have a separate mailing address? · if it applies

  Yes · No

• Mailing Address Street · if it applies

• Mailing Address City · if it applies

• Mailing Address State · if it applies

  51 choices

• Mailing Address Zip Code · if it applies

• Home Phone · optional · if it applies

• Mobile Phone · optional · if it applies

• Text Phone · optional · if it applies

• "By checking this box, you agree to receive text messages from Byrd Barr Place related to your application. (full text under What you agree to) · if it applies

  Yes · No

• What is the best way to contact you about your application? · if it applies

  Email · Mail · Phone Call · Text Message

• What is the best time of day to contact you? · optional · if it applies

  Morning (8AM - 11AM) · Afternoon (12PM - 3PM) · Later Afternoon (4PM - 6PM)

• Do you wish to be added to our Do Not Contact list? · optional · if it applies

  Yes - do not send me information about other programs

• How would you describe your home? · if it applies

  Hi-Rise (Three-story or more apartment building) · 1-3 Family (Single Family Detached Home, Duplex or Triplex) · 4+ Family (Four-plex, Townhouse, Row house or One and Two Story Apartment Building) · Mobile Home (A movable dwelling 8 feet or more wide and more than 40 feet in length) · RV (A mobile/manufactured home, houseboat, camper, recreational vehicle/motor home or boat 40 feet or less in length)

• How would you describe your housing status? · if it applies

  I own my home/I am buying my home · I receive Section 8 Housing Assistance/I live on a Tax Credit Property · I am renting my home · I rent a room in a home · I live in temporary housing

• How many bedrooms does your home have? · if it applies

• When did you move into your home? · if it applies

• How much is your rent or mortgage every month? · if it applies

• Is heat included with your rent? · if it applies

  Yes · No

• How is your home heated? · if it applies

  Electric · Natural Gas · Wood · Propane

• How is your home heated? · if it applies

  Seattle City Light · Puget Sound Energy · Oil · Wood · Propane

• Who is your oil provider? · if it applies

  7 choices

• If 'Other,' please provide the name of the company: · if it applies

• Does your home have an additional source of heat? · if it applies

  None · Seattle City Light · Puget Sound Energy · Oil · Wood · Propane

• Who is your oil provider? · if it applies

  7 choices

• If 'Other,' please provide the name of the company: · if it applies

• Do you have a Social Security Number? · if it applies

  Yes · No · No, but someone else in the household does

• Social Security Number · optional · if it applies

• Date of Birth · if it applies

• What is your gender identity? · if it applies

  Male · Female · Non-binary · Decline to self-identify

• Are you Hispanic/Latino? · optional · if it applies

  Yes · No

• Do you have any disabilities? · optional · if it applies

  Yes · No

• Are you a military veteran? · optional · if it applies

  Yes · No

• Do you currently have health insurance? · optional · if it applies

  Yes · No

• Education · optional · if it applies

  0-8 · 9-12 Non-Graduate · High School Graduate/GED · 12+ Some Post-Secondary · 2 or 4 Year College Graduate

• Race · optional · if it applies

  7 choices

• Did you receive ANY income in the last 3 months? · if it applies

  Yes · No

• What type of income did you receive? · if it applies

  12 choices

• I certify that the above information for income is true and correct to the best of my knowledge. · if it applies

  Yes

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• 1 · if it applies

• 2 · optional · if it applies

• 3 · optional · if it applies

• Please share with us why you have not received income in the last 3 months: · if it applies

• Please share how you have been meeting your basic living needs for food, shelter and utilities: · if it applies

• I certify that the above information for income is true and correct to the best of my knowledge. · if it applies

  Yes

• Including yourself, how many people live in your household? · if it applies

  15 choices

• Are you interested in receiving assistance for Furnace Repair, Replacement or Cleaning? · if it applies

  Yes, my furnace needs cleaning · Yes, my furnace is not working · No

• If eligible, are you interested in receiving a portable air conditioner? · optional · if it applies

  Yes

• Name

• Date of Birth

• Identification Number

• Telephone Number (Include Area Code)

• Address

• City

• State

• Other Information · optional

• Please check all below who are included in this consent in addition to DSHS and identify them by name and address:

  Social Security Administration or other federal agency: LIHEAP · See Attached List · Other

• 2. Reason for disclosure

  Continuity of care · Legal · Personal · Other

• I authorize and consent to sharing the following records and information (check all that apply)

  All my client records · Records on attached list · Only the following records · Payment records

• I have read the above LIHEAP information and certify the information I have entered · if it applies

  Yes

• I have read the above information regarding PSE HELP and certify the information I have entered · if it applies

  Yes

• Past Due Bill Forgiveness plan is for income-qualified customers who have first enrolled in PSE’s Bill Discount Rate and received PSE HELP, to assist in eliminating their past-due charges. (full text under What you agree to) · optional · if it applies

  I am interested in the Past Due Bill Forgiveness plan with the terms and conditions described herein.

• I have read the above Energy and Money Saving Tips · if it applies

  Yes

• Please check the boxes for any missing document(s) you were not able to upload today. (full text under What you agree to) · optional · if it applies

  Utility Bill w/ Name, Account # and Address · Past 3 months of Income Documentation for all Household Member(s) · SSN Documentation for all Household Members · Residence Document(s) (if utilities included with rent)

• How would you describe your experience with this application? · optional · if it applies

  It was very simple and easy to complete · The questions were phrased in a confusing way · The layout was overwhelming · I had difficulty gathering the necessary documents · I had difficulty finding this application form · I had difficulty finding a computer and/or internet access

• Please provide any additional feedback here: · optional · if it applies

Household Member: answered for each person (First Name, Middle Name, Last Name, What is the relation to the primary contact?, Is this person under 18 years of age?, Date Of Birth, Is this household member currently enrolled in High School?, Does this household member have a Social Security Number?, Social Security Number, What is this household member's gender identity?, Is this household member Hispanic/Latino?, Does this household member have any disabilities?, Is this household member a military veteran?, Does this household member currently have health insurance?, Education, Race, Did this household member receive income in the last 3 months?, What type(s) of income did you receive?, 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3, Please share with us why you have not received income in the last 3 months:, Please share how you have been meeting your basic living needs for food, shelter and utilities:, I am the person above or their legal guardian and I certify that the above information for my income is true and correct to the best of my knowledge.).

• Byrd Barr Place reviews the application, a different advocate validates it, and the state reviews awarded applications before a utility payment.
• Keep paying your bills while waiting. Ask your utility for a payment arrangement if needed.
• Federal LIHEAP allows states to use categorical benefit status or income ceilings. Washington publishes its own 150% federal poverty guideline rule. The federal ceiling is not a replacement for local eligibility review.
• Send missing information within 90 days of signing. Otherwise the application expires.
• A grant may take one or two billing cycles to appear. A direct-payment check may take six to eight weeks after processing.
• The agency says applications with a disconnect notice are processed within 72 hours. Contact the agency for urgent help.
• Byrd Barr Place may award or reject the application after validation.
• Byrd Barr Place contacts you when required documents or information are missing.
• You may request a fair hearing if LIHEAP is not acted on within a reasonable time or benefits you believe you qualify for are denied.

• You do not need a shutoff notice to apply for LIHEAP.
• Being listed on another household’s LIHEAP grant prevents a second grant in the same program year, even after moving.

• Check current funding and appointment availability with the agency. No exact closing day is supplied.
• The Google Drive blank Byrd Barr Place packet could be viewed by title, but robots.txt disallows the public download path. No PDF placement or recipe was made.
• The live e-signature and confirmation steps after Submit were not visited. Never submit made-up people.
• Staff-only and hidden legacy fields are preserved only in byrd-fields.txt. The hidden LIHWAP branch says it ended in March 2024 and must not become current water assistance.
• The current fact contract cannot represent selected text-list membership, nested repeat records, or computed client-side helper conditions. Such conditions remain unknown.
• The current schema cannot attach conditions to attestations. No-income, DSHS and PSE declarations are preserved with their original wording, but must stay in their printed conditional branches. No separate required-field helpText field or notes field exists. Printed help and conditions remain in the cached field extraction and numbered form text.
• The schema has no phone or email submission method. Those documented channels are named in the submission instructions.
• Opportunity Council’s actual appointment interview, consent text and signed benefit application are not public here. Only its appointment prescreen and contact form are captured.
• Chart, contact and form-availability conflicts are logged in data/source-issues.json. The program page lists 360-255-2192 for Island scheduling, while the scheduler lists 360-639-8876. The exact Opportunity Council countable-income calculation is not captured; do not assume Byrd Barr Place’s earned-income deduction applies.
• The page says applications should be submitted by August 2027, but gives no exact closing day.
• The chart is labeled 2025-2026 while the form is for 2026-2027. Confirm the current income table.