Energy Savings Assistance Program and 护理/得到 Enrollment Process 西班牙语 Fill out the form to see if you qualify for: 可持续发展目标的每月折扣&E®法案 No cost energy efficient home improvements that will save you money and energy now and for years to come 联系信息 西班牙&E Account Number (If Available) 第一个名字 姓 家庭住址 公寓号码 城市 邮政编码 我的西班牙&电子账单来自 直接来自可持续发展目标&E 来自我的房东 这是一个活动房屋吗? 是的 No 主要的电话 备用电话 电子邮件地址 电子邮件地址 确认邮件地址 住户人数 成年人 孩子们 Are you or a member of your household disabled? 是的 No 宁愿不说 资格 Qualification may be based on total household income or participation in certain public assistance programs. Do you participate in certain public assistance programs? 是的 No 公共援助计划 I am currently enrolled in one of the following programs: Medicaid/Medi-Cal for Families A & B 食品券/ SNAP Head Start Income Eligible (Tribal Only) Bureau Of Indian Affairs General Assistance Woman, Infants And 孩子们 Program (WIC) National School Lunch Program (NSLP) Low Income 首页 Energy Assistance Program (LIHEAP) Supplemental Security Income (SSI) TANF或部落TANF 家庭规模 护理 欧洲航天局 得到 1 $39,440 $36,450 不合格的 2 $39,440 $49,300 不合格的 3 $49,720 $62,150 $49,721-$62,150 4 $60,000 $75,000 $60,001-$75,000 5 $70,280 $87,850 $70,281-$87,850 6 $80,560 $100,700 $80,561-$100,700 7 $90,840 $113,550 $90,841-$113,550 8 $101,120 $126,400 $101,121-$126,400 每个额外的人 +$10,280 $12,850 +$10,280-$12,850 *Total household income is all taxable and non-taxable revenues, 来自所有家庭成员, 从任何来源, including but not limited to: wages, 工资, 感兴趣, 股息, spousal and child support payments; public assistance payments, 社会保障及退休金, 租金收入, 自雇入息, and all employment-related non-cash income. Effective June 1, 2023 – May, 31, 2024 家庭收入 If you do not participate in any public assistance programs, please check all sources of total annual household income for all members of the household Wages And/Or Profits From Self-Employment 租金或特许权使用费收入 养老金 社会保障 SSP或SSDI Disability Or Workers’ Compensation Payments 失业救济金 Scholarships, Grants Or Other Aid For Living Expenses Interest/Dividends From Savings, Stocks, Bonds Or Retirement Accounts 配偶或子女抚养费 保险或法律和解 现金或其他收入 输入其他…… If you do not participate in a public assistance program, please enter your total annual household income (Taxable or Non-Taxable) before deductions in the space provided below: $ What is your language preference of choice? What is your language preference of choice? -无-没有一个中国人塔加拉族语越南西班牙语 If you are an agency or contractor please add your source code and employee ID# here. Customers please skip and proceed to 条款 And 条件. 源代码 雇员ID # 条款与条件 I state that the information I have provided in this application is true and correct. 我同意 to provide proof of income if asked. 我同意为可持续发展目标提供信息&如果我不再有资格. I know that if I receive any discount without qualifying for it, I may be required to pay back the discount I received. 我理解可持续发展目标&E can share my information with other utilities or their agents to enroll me in their assistance programs. If you qualify for the no cost home improvement upgrades (The Energy Savings Assistance Program) you will receive a call from our authorized contractor to set up a time for an in-home visit to see what services you may qualify for. They will then inform you of the next steps. Please Check The Box Below If You Agree To The Above 条款 And 条件 * 我同意 提交