You will need to bring the following documents to your appointment, or you will need to make photocopies of all of the following documents if you are mailing in your application, drop off your emergency application, or are submitting it through a partner organization.
You must submit a new application and supporting documents each time you apply. Byrd Barr Place is required to collect all the specified information each year to ensure that it is current and valid.
You can find this year’s application packet here for the LIHEAP and PSE HELP Programs:
The following 7 documents are needed for a complete application:
1. Signed and dated application. Information for all household members, including yourself, must be filled out completely.
2. Copy of your most current utility bill OR name of energy vendor and account number (*Urgent/Final/Shut off notice is required for expedited processing*). For PSE HELP, the primary applicant must be the customer or co-customer on the bill. If not, you must call your utility to add your name to the account before submitting your application.
3. Copy of social security cards for ALL household members, including all children. You must provide social security cards or legal proof of residency for all household members. For LIHEAP only, if you or a household member doesn’t have a social security number, call Byrd Barr Place at 206-812-4940 for more information on the other types of documents we accept. Your household may still qualify.
4. Copy of valid picture ID for all household members 18 years or older. This may include a copy of a person’s driver’s license, or state ID. For PSE HELP, your driver’s license or state ID cannot be expired.
5. Copy of CURRENT lease, rental agreement, or mortgage coupon/ property tax statement. This document must show the primary or secondary applicant’s name on it. Resident address must match address on the bill.
6. Read and sign “Energy Savings Tips” Form.
7. Copies of all income documents for each person over 18 years old for the 3 previous months, not including the month you sign the application, OR the last 12 months of income if you do not qualify based on 3 months. Income is any amount of money coming into the household whether from a job, benefits, family member, child support, unemployment or self-employment.
In the table below, look for the month in which you signed the application.
Please provide the gross income received by all household members for the 3 months before that.
|January||October, November, December||July||April, May, June|
|February||November, December, January||August||May, June, July|
|March||December, January, February||September||June, July, August|
|April||January, February, March||October||July, August, September|
|May||February, March, April||November||August, September, October|
|June||March, April, May||December||September, October, November|
Provide the following documents for each income type for all adult household members:
- No income: Each person in the home (over 18 years old) must fill out their own “Declaration of No Income” form if they did not receive any money or were not paid by their employer in any or all of the 3 previous months. This form MUST be filled out completely. You must make copies for each person.
- Benefits or assistance (SSI, SSA, SSDI, ABD, GA, TANF, Veterans, retirement, and pension): Current years benefit letter, or itemized bank statement showing the deposit in the month prior. To print a Social Security letter, log on at ssa.gov/myaccount/.
- Unemployment: A printout of weekly gross payments from Employment Security or all weekly paystubs with dates for the previous 4 months. Go to esd.wa.gov and select “Get Claim or Wage Information” to create an account and print payment information. Or, make an appointment at your local WorkSource location to request a printout.
- Self-employment income: Bank statements or ledgers must be provided for proof of gross income, and itemized receipts to deduct business expenses. Call 206-812-4940 for further directions and required documents. A “Self-Employment Declaration of Income” Form is required.
- Cash, personal checks, reoccurring payments from family, or other income not listed: Must complete a “Self-Declaration of Income” form and include bank statements or receipts as income documentation. Contact Byrd Barr Place to get this form and ask questions, or go toByrd Barr Place’s website.
- Rental income: Current lease agreement or proof of payments received (check or bank statement).
- Child support: DSHS printout of monthly or weekly payments, OR a signed statement from payer. Log on at https://secure.dshs.wa.gov/home to print payment information through DSHS.
- COPES caregiving income: Go to your online Individual ProviderOne portal to obtain payment information. Log on at https://fms.publicpartnerships.com/PPLPortal/login.aspx.
- Earned income: (Only the following are accepted.)
- All paystubs (usually received 2 to 4 times a month) that show gross income (before taxes) with the “pay date” that falls in the previous 3 months. Do not include paystubs with pay dates in the month the application is signed.
- Signed statement from the employer with gross wages, including all tips, commission, bonuses, etc.
- Complete and sign “Employer Earned Income Request” form that Byrd Barr Place can send to the employer.
If you or a household member needs one of the forms listed or you are not sure what documents to provide, please contact Byrd Barr Place. We can mail or email documents to you.
8. Return your application.
If you are not applying in-person, you may drop off your application between 9 am and 4 pm, Monday through Friday at Byrd Barr Place or mail your application to:
Byrd Barr Place
ATTN: Energy Assistance
722 18th Ave
Seattle, WA 98122
For information on next steps, please visit our After You Apply page.
Click here to find out if you are eligible.
How to Apply
Click here for information on how to apply.
Click here to know what to include with your application.
After You Apply
Click here to find out what to do after you submit your application.
Frequently Asked Questions
Click here for additional information on our Energy Assistance Program.