Partner Referral - Utility Assistance 

This referral form is to be used to connect your clients whose services are off, or are facing imminent disconnection, within 24 hours.  We are also using this form as a means of keeping you informed about the availability of utility assistance and how to apply.

STANDARD ASSISTANCE 

Standard/Regular Assistance - How to apply

  GENERAL, NON-EMERGENCY ASSISTANCE – APPOINTMENT NOT REQUIRED!

 

DID YOU KNOW THAT YOUR CLIENT CAN CONVENIENTLY SELF-APPLY FOR HEAP/PIPP?  

If services are on, an appointment is not required!

 

The Ohio Department of Development has an online client portal that allows client to self-apply/self-reverify for HEAP/PIPP at Ohio Department of Development, or client may submit a paper application and documents by mail:

 

·         Mail to the state - Office of Community Assistance, Home Energy Assistance Program P.O. Box 1240, Columbus, Ohio 43216

 

 DON'T WAIT - KNOW THE DATES!

To avoid being dropped from PIPP, please work with your client to act timely. The PIPP reverification and anniversary dates are printed on the utility bill. It is the responsibility of the customer to know their dates and apply up to 2 months in advance as standard processing time is 8-10 weeks, county wide.

Application download - English

Application download - Spanish


CRISIS ASSISTANCE 

Standard/Regular Assistance - How to apply

CRISIS UTILITY ASSISTANCE – APPOINTMENT REQUIRED!

 

To schedule an emergency/crisis appointment, please call 216-600-8108, or visit our on-line web scheduler at chn.itfrontdesk.com

Please note: 

 

·         WINTER CRISIS - Payment assistance for gas/electric heating is available Nov. 1st - March 31st.  

·         SUMMER CRISIS - Payment assistance for electric/cooling is available during   July 1st – Sept. 31st.  

·         OTHER - Programs such as County PRC and/or FSI may be available to leverage, or in lieu of the above.

 

*** During a crisis appointment, client will be assisted in applying for all available utility assistance programs - crisis/non crisis/fuel fund 

 

 

(WCP) Winter Crisis - A Crisis Appointment is required.  Available Nov 1st - March 31.  175% FPL. Open to homeowners and renters. Eligible households may receive a payment to prevent disconnection or restore electric/gas services.  Upon scheduling an appointment, the customer account will receive a one time, 30-day hold to prevent disconnection.  This allows time for the client to be attended.

 

(SCP) Summer Crisis - A Crisis Appointment is required.  Available July 1 through Sept. 31.  175% FPL. Open to homeowners and renters. The last two years, the state extended the period through end of September.  Eligible households may receive a payment to prevent disconnection or restore electric services and may also be eligible for a cooling unit - fan/ac, or repair to a central air system. No holds are placed on account during summer crisis.


REQUIRED APPLICATION DOCUMENTS 

REQUIRED APPLICATION DOCUMENTS


The State requires the following documents. Failure to submit required documentation and information may lead to application processing delays.

  

  • Photo ID: required for each name listed on the gas and/or electric bill 

  • Social Security Cards: required for all household members. Accepted forms include printouts from Social Security with full SS# on them, Medicare Cards, and OWF SNAP printouts 

  • Birth Certificates for all household members are required; newborn birth letter is acceptable, anyone else in the household needs a birth certificate on file 

  • Current gas, electric, water and sewer bills:   If bills are in the landlord's name, a lease is required to demonstrate tenant responsibility. 

  • Proof of Income is required for the last 30 days for all household members 18 years of age and older. Acceptable documents include SSA, SSI and SSDI award letters, Pension statement, Child Support, Utility Assistance documents 

    • Individuals paid weekly need the last 4 paystubs 

    • Individuals paid bi-weekly need 2-3 paystubs (make sure you have all paystubs for the last 30 days) 

    • Individuals paid semi-monthly need 2 paystubs 

    • Individuals paid month need 1 paystub 

    • If paystubs are not available, you will need verification of your income from your employer (i.e., a printout of your last 30 days of pay) 

    • Seasonal employees are required to provide 12 months of income documentation - if paystubs are not available, a printout from your employer is required 

  • No Income: If the household has no income, or no verifiable income, you will need the following: 

    • IRS Tax Transcript 

    • If you file a tax return, you can call the IRS at 1-800-908-9946 

    • If you did not file a return, you can call the IRS at 1-800-829-1040 

    • You can go to the IRS website at www.irs.gov/individuals/get-transcript 

    • You can visit the IRS office in the Federal Building at 1240 East 9th St. Monday through Friday between 8:30 a.m. and 4:30 p.m. 

  • Download the English application here

  • Download the Spanish application here


EMERGENCY REFERRALS

Please complete this form only if the client you are assisting is facing imminent disconnection of their utility service (within 24 hours) or has already been disconnected. Clients whose service is off will be contacted within 24 hours of CHN's receipt of this referral form.    

Please note: Certain funding is only available at specific times of the year to eligible clients as follows: 

·       Assistance for gas/electric heating is available during the Winter Crisis Program which runs Nov. 1st - March 31st

·       Assistance for electric/cooling is available during the Summer Crisis Program which runs July 1st - August 31st.  

·       Outside of these timelines, programs such as PRC and/or FSI may be available.  

 

***Upon submission of your referral, a confirmation receipt will be provided.  Note that program information and account details will only be discussed with the client.  Per state guidelines, we are unable to provide any specific information to the referrer, but client may share with the referrer if they wish.   














By checking yes, you confirm that client is aware that they will be contacted for utility assistance by CHN


Must match the name provided on W9









Gas Utility

Gas Utility



Electric Utility






UTILITY ASSISTANCE PROGRAM INFORMATION 

Contact Information