Ask us about households larger than 10.
*Gross income means all income before any deductions.
Current limits effective as of 3/2/2026 until further notice.

 

 

In order to process your weatherization application, we need copies of the following documents. You will have the opportunity to upload copies at the end of this application. Alternatively, you can contact us and send them in separately if you do not currently have them on hand.

 

In addition to completed forms, we will need copies of the following documents. Please do not send original documents to us.

• Proof of Income: Please provide paystubs and any other income documentation received in the previous 60 days for each household member who is either turning 18 in this calendar year or is over 18 and NOT currently in High School. Please include copies of:Copy of Social Security Cards for all household members
• Copy of electric bill
• Copy of gas bill, if applicable
• Proof of identification for all household members over 18, which can include the following:
  • Driver’s License, Passport, Military ID, State ID/Government issued ID, Birth Certificate, Social Security Paperwork, Tribal ID.
• Copy of the mortgage statement, deed, or manufactured structure ownership document.

 

If you receive any of the following types of income, please include copies of:

• Wages - copies of paycheck stubs for 60 days prior to date on application
• Social Security, SSDI or SSI - current year benefit verification letter
• Pension – payment statement, award letter
• Temporary Assistance for Needy Families (TANF) - award letter
• Alimony or child support - award letter
• Unemployment – benefit verification letter or award summary

 

If you rent your home, you must provide your property owner’s information and signature on the Weatherization Supplemental form. We do not provide weatherization to renters without the agreement and permission of their property owner. If you have any questions, please contact us at homewx@neighborimpact.org or 541-316-2034.

 

 

Part 1: Applicant Notice, Program Disclaimers, and Applicant Responsibilities, Waiver & Release

Effective 10/01/2025

• I, Applicant, understand that the government energy and weatherization assistance programs are voluntary and that my application is subject to a review process to determine my household's eligibility.
• I understand that in order for my household's application to be considered, I must submit a complete application that provides all required information.
• I understand that I may be required to provide additional information or documentation to determine my household's eligibility.
• I understand that my household's application and additional information or documentation materials will all become part of my household's application ("Application").
• I understand that determinations on assistance eligibility are made by the state's Oregon Housing and Community Services (OHCS) department in conjunction with contracted subgrantee agencies ("Subgrantees").
• In the event that my household's application is denied, I may be entitled to a review of my Application under applicable Oregon Administrative Rules.
• Upon successful enrollment in the LIHEAP/OEAP programs, I further authorize OHCS, and the State of Oregon, including designated subcontractors, and OHCS Subgrantees to release my Application and ongoing LIHEAP/OEAP program benefit information held by OHCS (including its subcontractors and OHCS Subgrantees) to the Energy Services Provider (as defined below) for the purposes of administering, monitoring, researching, and evaluating LIHEAP/OEAP program delivery and efficiency.
• I declare that the information I provide to complete my Application is true and correct.
• I agree to comply with the government energy and weatherization assistance program requirements for eligible households.
• Should I receive any heating and/or cooling equipment as a result of my eligibility to these programs, I agree to hold OHCS, its sub-grantees and/or contractors harmless.
• I agree that I am responsible to return ineligible funds or funds used improperly.
• I authorize and hold harmless OHCS (including its subcontractors and OHCS Subgrantees) to release my Application and ongoing LIHEAP/OEAP program benefit information up and until one (1) program year following my participation in the LIHEAP/OEAP programs.

Part 2: Applicant Notice, Waiver & Release Related to Energy Service Providers & Applicant's Energy Service Account Information

• I understand that the State of Oregon, including OHCS, its designated Subcontractors, and Subgrantees, may request information related to my energy services account(s) ("Account") from my energy service provider(s), including but not limited to fuel supplier, vendor, or other similar entity providing similar services ("Energy Services Provider"), once my household applies for energy assistance through one of the energy assistance programs, including but not limited to the Low Income Home Energy Assistance Program (LIHEAP) and Oregon Energy Assistance Program (OEAP).
• I understand that information related to my Account may be required by the State of Oregon, OHCS, its designated subcontractors, and Subgrantees for the purposes of, including but not limited to, determining my household's energy assistance eligibility, and administering, monitoring, researching, and evaluating the energy assistance programs (all of which is determined by OHCS in its sole discretion).

With my signature,

• I acknowledge that I am the account holder (or the account holder's authorized agent) for the Energy Services Provider Account(s) identified in this Application.
• I hereby authorize and hold harmless my Energy Services Provider(s) to release and provide any and all information relating to my account, including but not limited to account number, account name, service address, billing dates and amounts charged, information related to collections actions, other miscellaneous account charges and information, or other similar account data as may be requested by OHCS or its designated subcontractor (hereinafter "Account Information") to the State of Oregon, OHCS, its designated subcontractors, and Subgrantees.
• I understand and agree, should I receive any heating and/or cooling equipment as a result of any of these programs, I agree to hold OHCS, it's sub grantees and/or contractors harmless.
• I hereby authorize and hold harmless my Energy Services Provider(s) for such release of my Account Information for up to two (2) energy assistance program years (10/1 to 9/30) prior to my Application and for three (3) program years (10/1 to 9/30) after my Application is submitted.
• I hereby authorize and hold harmless the State of Oregon, OHCS, its designated subcontractors, and Subgrantees in the use as authorized by OHCS in its sole discretion of my released Account Information.

Part 3: Applicant Signature

With my signature I hereby provide the required authorization, approval and acknowledgements to both PART 1 and PART 2 of this ENERGY/WEATHERIZATION ASSISTANCE APPLICATION-REQUIRED APPLICANT DISCLOSURES AND APPROVALS.

Applicant Disclaimer: I agree to allow use of the information collected for all NeighborImpact programs, Oregon Housing and Community Services Department, its agents, and sub grantees for any legitimate purpose including, but not limited to the purpose of deciding eligibility for any and all weatherization assistance programs available, for reporting associated with those assistance programs and for reporting and monitoring associated with those assistance programs. 

NeighborImpact uses a statewide database called OPUS. My signature below indicates that I consent to my household/family information being entered into OPUS and I am aware that it may be shared with other OPUS partners for the purpose of service delivery.

I/we certify that the information provided in this application is true and correct as of the date set forth below, and acknowledge my/our understanding that intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. And liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.

Please use the secure file upload feature below to upload the following documents:

• Proof of income for all household members over 18 who are not in high school
• Copy of Social Security Cards for all household members
• Copy of electric bill
• Copy of gas bill, if applicable
• Proof of identification for all household members over 18, which can include the following: Driver's License, Passport, Military ID, State ID/Government issued ID, Birth Certificate, Social Security Paperwork
• Copy of the mortgage statement or deed of home or title of mobile

If you receive any of the following types of income, please include copies of:

• Wages - copies of paycheck stubs for 60 days prior to date on application
• Social Security, SSDI or SSI - current year benefit verification letter
• Pension – payment statement, current bank statement, award letter
• Temporary Assistance for Needy Families (TANF) - award letter
• Alimony or child support - award letter or child support case number
• Unemployment - benefit print out