Great Northern Services

310 Boles Street

Weed, CA 96094
(530) 938-4115
Fax (530) 938-1040
www.gnservices.org

2024 Energy Assistance and Weatherization

Application Instructions
Keep for Your Records
All necessary supporting documentation must be dated within 30 days of the date you submit your
application. An incomplete application will prevent you from receiving assistance.
• Use only blue or black ink.
• Please cross out mistakes and initial the change. Do NOT use white out.
Helpful documents included in this packet
• Monthly Budget Planning Guide: This guide is to help you plan your monthly budget so you are
able to meet each of your household needs. Keep this for your records.
• 2024 Fact Sheet-Income Guidelines: Please read thoroughly. Eligibility is based on the household’s
total gross monthly income, which cannot exceed the 2024 LIHEAP Income Guidelines listed within.
Current recipients of CalFresh or CalWORKs benefits are categorically eligible for LIHEAP.
• Energy Education Pamphlet & WattSmart Energy Savings Guide: These contain information on
how to reduce your energy costs and how much items in your home cost to operate.
The following supporting documentation MUST BE INCLUDED with your application packet:
• ID: Applicants must provide proof of government photo identification (ID), such as a state ID card,
a driver’s license, a US Passport, a U.S. military card (front and back), or a Permanent Resident
Card. Expired ID is acceptable for a period of one year from expiration date. For seniors 60 and
over, an expired government issued ID is acceptable regardless of expiration date.
• Income: Provide copies of all income verification for everyone in the household. All verification
must be dated within 30 days of submitting the application and it must reflect a full consecutive
month. Each person over 18 years of age without an income needs to complete and sign the
CERTIFICATION OF INCOME AND EXPENSES – CSD43B (High School students are excluded).
CalFresh/CalWORKS recipients can self-certify their household income on the CSD 43 Intake Form.
• Pacific Power Bill: Provide a copy of all pages of the household’s most recent electric bill. It cannot
be a “final or closing bill” and there needs to be a minimum of 22 elapsed days in the billing cycle. If
the power bill is not in the applicant’s name an Account Holder & Authorization Form (CSD 081)
must be completed with the account holder’s name and signature.
• Fuel/Propane Bills: Provide copies of all other current energy bills dated within the last 30 days for
propane, heating oil and/or kerosene or full out the Usage Form included in the application.
Provide this information even if you are not requesting assistance with fuel because it
demonstrates your total energy costs and energy burden.

Si prefiere una Solicitud en Idioma Español o desea analizar su solicitud con una persona en español,
llame al 530-938-4115 ext. 131
 Great Northern Services
310 Boles Street
Weed, CA 96094
(530) 938-4115
Fax (530) 938-1040
www.gnservices.org

Energy Assistance and Weatherization

Examples of Proof of Income
Keep for Your Records
*NEW* Current recipients of CalFresh or CalWORKs benefits are categorically eligible for LIHEAP.
Those households need to provide verification of CalFresh/CalWORKS benefits dated within the last 30
days and self-report income for each household member of the Energy Intake Form (CSD 43) in this
packet.
If no one in the household receives CalFresh or CalWORKS, the following documentation is required:
Proof of income is required for everyone in the household 18+ and not a high school student.
All documents provided need to include a name or SSN to be acceptable verification of income.
• SSA/SSI/SSP/SSDI: 2024 Annual Award Letter from Social Security, bank statements reflecting
direct deposit amounts or checks dated within the last 30 days.
• Pension/Annuities: Please provide 2024 annual statements or copies of checks dated within the
last 30 days from each pension plan. You need to provide proof of the gross amount received. If
you provide a bank statements reflecting direct deposits you should also include your most recent
1099 form to verify withholding status.
• Wages/Paychecks: Copies of all check stubs/receipts dated within the last 30 days, reflecting a
FULL CONSECUTIVE MONTH of pay for the last 30 days worked. Be sure that the dates are in
chronological order and that there are no gaps between pay periods or missing stubs/receipts. If
there was a gap in work with no pay, please attach a brief explanation.
• Unemployment Benefits: Copies of EDD documentation reflecting a FULL CONSECUTIVE month
dated within the last 30 days. Please provide current check stubs or a current printout from the
EDD of payments received, not an award letter.
• Self-Employment/Odd Jobs: All household members who are self-employed and/or perform odd
jobs within the last 30 days will need to complete, sign and date a “Self-Certification of Household
Income Verification” showing the amount that has been earned in the last 30 days.
• Child/Spousal Support: Copies of checks, bank statements reflecting direct deposits or other
documentation reflecting a FULL CONSECUTIVE MONTH dated within the last 30 days.
• Worker’s Compensation: Copies of recent check stubs or other documentation reflecting a FULL
CONSECUTIVE MONTH for the last 30 days.
• Other Income: If any other forms of income are received that are not listed above, documentation
can be provided on bank statements for direct deposits or checks dated within the last 30 days.
 Great Northern Services
310 Boles Street
Weed, CA 96094
(530) 938-4115
Fax (530) 938-1040
www.gnservices.org

Energy Assistance and Weatherization

Program Information
Keep for Your Records

• The Low Income Home Energy Assistance Program (LIHEAP) is a federally funded program that is
administered by the state of California to assist low-income or struggling households pay their
energy bill. You can receive assistance one time each program year for your electricity, fuel oil,
propane or firewood. To qualify for assistance through Great Northern Services you must be a
Siskiyou County resident.
• Completing an application is not a guarantee for assistance. Applications are processed according
to a state mandated point system, not on a first come first serve basis.
• It may take several months to process your application. You may be contacted to provide updated
documentation when your application comes up for review. You will need to keep your energy bills
current and make payments to your energy provider in a timely manner. Do not wait until you
have a shut-off notice or are without fuel or firewood to apply.
• You will be notified when we receive your application and again if assistance can be provided.
• Weatherization assistance helps qualifying households reduce their heating and energy costs by
installing energy saving measures in a home. Indicate on the application if you would like to be
consider for weatherization services.
• Apply online: Great Northern Services uses ShareFile and RightSignature to give clients a safe and
secure way to apply for Energy Assistance and Weatherization online if they prefer. Visit
gnservices.org/apply for more information.
• Apply by mail:
Send the entire application by U.S. Mail to
Great Northern Services – ATTN: Energy
310 Boles Street
Weed, CA 96094
• For personal assistance in completing the application you can call 530-938-4115 ext. 120 or text
530-938-4115 (message & data rates may apply); stop by our office Monday – Thursday, 9 am – 4
pm; or visit your local Community Resource Center (see list on next page).
• Spanish language assistance is available, please call 530-938-4115 ext. 131 to schedule a phone call
or in-person appointment.
• For weatherization questions or assistance, you can call 530-938-4115 ext. 127 or stop by our office
Monday – Thursday, 9 am – 4 pm. You can also email [email protected] with questions.
 Great Northern Services
310 Boles Street
Weed, CA 96094
(530) 938-4115
Fax (530) 938-1040
www.gnservices.org

Energy Assistance and Weatherization

Resource Information Guide
Keep for Your Records
Pacific Power
CARE Program: Income-qualifying residential customers can receive a 20 percent discount on Pacific
Power bills through the California Alternate Rates for Energy (CARE) program. You can contact Pacific
Power by phone at 1-888-221-7070 and ask about their payment plans and/or obtain an application for
the CARE program, or enroll through their Website: www.pacificpower.net/care

Siskiyou County Community Resource Centers

• Dunsmuir Community Resource Center: 5844 Dunsmuir Ave, Dunsmuir. 530-235-4400.

• Happy Camp Family Resource Center: 38 Parkway Rd., Happy Camp. 530-493-5117.
• HUB Communities Family Resource Center: 310 S. 13th St., Montague. 530-459-3481.
• McCloud Community Resource Center: 303 Main St., McCloud. 530-925-6015.
• Mount Shasta Community Resource Center: 109 E. Lake St., Mt. Shasta. 530-926-1400.
• Scott Valley Family Resource Center: 11920 Main St., Fort Jones. 530-468-2450.
• Tulelake/Newell Family Resource Center: 810 Main St., Tulelake. 530-667-2147.
• Family & Community Resource Center of Weed: 260 Main St., Weed. 530-938-9914.
• Yreka Community Resource Center: 201 S. Broadway, Yreka. 530-842-1313.

Most resource centers have copies of our applications on hand. They can help fill applications out,
provide additional instructions, and submit the applications to us by fax. In addition each center has a
wide variety of other services. Please call first to verify hours and availability of assistance.
 Great Northern Services
310 Boles Street
Weed, CA 96094
(530) 938-4115
Fax (530) 938-1040
www.gnservices.org

Energy Assistance and Weatherization

Monthly Budget Planning Guide
Keep for Your Records
Below is a monthly budget sheet you can use to help plan what expenses you have to pay for every
month. It is helpful to take the average costs of 12 months and set aside an amount each month so in
the winter months you will be able to meet your heating cost needs.

To be responsible, calculate your income and budget your expenses in order to pay your monthly utility
and heating bills.

A Pacific Power CARE Application will be sent to you once your file has been processed. Income-
qualifying residential customers can receive a 20 percent discount on Pacific Power bills through the
California Alternate Rates for Energy (CARE) program. If you would like to fill out the CARE application
now, you can access the application at https://www.pacificpower.net/care.

Type of Income or Expense Income

Income
Paychecks, Cash from Odd Jobs
SSI, SSA, Unemployment
Pensions, Savings
Other
Income Subtotal

Expenses
Rent/Mortgage
Electricity
Propane
Heating Oil
Wood
Telephone
Medical
Food
Gasoline
Car Insurance
Entertainment/Other
Expenses Subtotal

Total (Income Subtotal - Expenses Subtotal)

 Great Northern Services
310 Boles Street
Weed, CA 96094
(530) 938-4115
Fax (530) 938-1040
www.gnservices.org

Energy Assistance and Weatherization

Online Application Available

Great Northern Services uses ShareFile and RightSignature to give you a safe and secure way to apply
for Energy Assistance and Weatherization. Our goal is to give clients the tools that work for them to fill
out and submit the necessary paperwork. No one is required to apply online but if you think it would
make the process easier for you, you are encouraged to visit our online application:

www.gnservices.org/apply

To apply online you need to have a reliable email address that you check regularly and digital versions
of your income and energy usage documentation. Photos of paperwork are often sufficient, provided
they are readable and printable. Please read all the instructions carefully.

Reporting Suspected Fraud, Waste, or Abuse

GNS is required to provide clients the information necessary to report fraud, waste, and abuse to the
U.S. Department of Health and Human Services Office of Inspector General Fraud hotline. If you wish
to report suspected incidents and activities, involving fraud, waste, and abuse of LIHEAP funds by GNS
employees, subcontractors, clients, or other parties affiliated with GNS you may do so by calling 1-800-
HHS-TIPS (1-800-447-8477) or visiting https://oig.hhs.gov/.

Some Weatherization projects are funded in part by the U. S. Department of Energy (DOE)
Weatherization Assistance Program. If you wish to report of allegations of fraud, waste, abuse, or
mismanagement in DOE programs or operations, you may call (800) 541-1625, email the OIG Hotline at
[email protected], or visit https://www.energy.gov/ig/ig-hotline for more options.

This portion of the application has been instructions, examples, and important information.
Please remove this first section before submitting your application and keep for your records.
 State of California-Health and Human Services Agency
DEPARTMENT OF COMMUNITY SERVICES AND DEVELOPMENT
2389 Gateway Oaks Drive, Suite 100, Sacramento, CA 95833
Telephone: (916) 576-7109 | Fax: (916) 263-1406
www.csd.ca.gov
DAVID SCRIBNER GAVIN NEWSOM
DIRECTOR GOVERNOR

2024 FACT SHEET

ENERGY ASSISTANCE PROGRAM

LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP)

Established in 1981, LIHEAP is a federally funded program that helps low-income households pay their energy bill. Assistance is
in the form of a dual or single party warrant or a direct payment to a utility company on behalf of an eligible applicant. Eligibility
is based on the household’s total monthly income, which cannot exceed the 2024 LIHEAP Income Guidelines listed below.
Current recipients of CalFresh or CalWORKs benefits are categorically eligible for the program. Because of significant funding
cuts, the federal government enacted a law requiring that states target households with low-incomes and high energy costs, taking
into consideration households with elderly and disabled persons, and children under six. This means there could be households
that received assistance in the past and will no longer receive assistance because they fall into a low priority group and are not
considered among the neediest of the needy. The amount of assistance is based on the number of persons in the household, total
gross household income, the cost of energy within the county the households resides, and funding availability. LIHEAP provides
one payment per program year. Under most circumstances, it takes approximately six weeks to process an application and pay the
applicant. However, an incomplete/incorrect application will take additional time to process. Persons living in board-and-care
facilities, nursing or convalescent homes, or in jail or prison, are not eligible for LIHEAP.

The local community services agencies are responsible for processing applications and the Department of Community Services and
Development (CSD) is responsible for issuing LIHEAP payments. To find out how to apply for services in Siskiyou County, please
call, ---530-938-4115 ext. 120---.

Utility companies throughout the state offer reduced rate programs. Customers should contact their utility company to find out if
they offer such a program and to request an application.

WEATHERIZATION ASSISTANCE PROGRAM

Weatherization is the process of making your home more “air tight” and energy efficient. The goal is to keep the warm air in and
the cold air out in the winter; and keep the cold air in and the warm air out in the summer. Weatherizing your home could help
lower your energy usage and utility costs. Your home will be assessed to determine what weatherization work can be done. The
most common types of weatherization include: sealing the holes and cracks, insulation, weather stripping, fixing windows, water
heater blankets and making sure your heating and air condition systems are working correctly.

Free weatherization services are available to low income property owners and renters. Eligibility is based on the household’s total
monthly income, which cannot exceed the income guidelines listed below. Current recipients of CalFresh or CalWORKs benefits
are categorically eligible for the program. To find out if you qualify, you must contact your local service provider. To find out how
to apply for services in siskiyou County, please call, ---530-938-4115 ext. 127--.
2024 LIHEAP INCOME GUIDELINES
Size of Household Monthly Income
1 $2,882.83
2 $3,769.83
3 $4,656.83
4 $5,543.92
5 $6,430.92
6 $7,317.92
7 $7,484.25
8 $7,650.58
9 $7,816.92
10 $7,983.17

NOTE: Income amounts for family sizes greater than six persons were determined based on the following calculation: Add 3% to
132% for each additional family member, multiply the new percentage by $66,527, and divide by 12. Example: household size of 7:
132% + 3% = 135% × $66,527 = $89,811 ÷ 12 = $7,484.25 per month.

Serving Low-Income Families Through Community Partners

 Manage energy.
Save money.

The first step to wise use of Residential energy use

Approximate average monthly kWh* use:
electricity is to understand Electric heat 2,200*

your energy use and habits. Electric heat pump

Baseboard/zonal/wall/portable heat
1,460*
1,400*
Central air conditioning 1,000*
Making simple changes in Electric water heater (3 people) 465**
Other heat (space, block, etc.) 180
how you use energy can help Furnace fan 102
Lighting 60
you save energy and money. Computer/printer
Refrigerator-freezer
45
44
Freezer 43
For information on our Clothes dryer
ENERGY STAR® refrigerator-freezer
37
35

Wattsmart® energy efficiency ENERGY STAR® freezer

Electric range/oven
35
23
© 2019 Pacific Power Wattsmart is registered in U.S. Patent and Trademark Office.

Flat-panel television 21
programs and tips to reduce Game system 20
Dishwasher 18***
energy use, visit Cable TV set-top box
Clothes washer
17
13***
BeWattsmart.com. Microwave
Coffee maker
11
10

Energy use can vary greatly according to the age or design of the appliance, the age of
your home and the number of occupants. In general, new homes and newer appliances
will use less energy.

*
Based on a 1,500 square foot home for a six-month period. Homes differ in usage and figures may be higher
than those indicated.
**
Based on a family of three. Add 100 kWh for each additional person.
***
Heating water for appliance use is included in water heater estimate, but not in dishwasher or clothes washer
estimates.
 Energy Education Pamphlet
GNS (530) 938-4115 ext. 120

NO-
NO-COST ENERGY SAVING TIPS LOW-
LOW-COST ENERGY SAVING TIPS HEALTH & SAFETY TIPS

Turn down your thermostat to Clean

Clean or replace furnace filters once a Adequate home heating is a necessity
68 degrees or lower during the day and month. of life. The inability to heat your home
evening (health permitting) and to adequately can put household
55 degrees or off at night or when Install weather-stripping or caulk to members at risk. Health and safety
away from home. Wear layers of loose- leaky doors and windows. risks include hypothermia and carbon
fitting clothes to trap body heat, such monoxide poisoning and the increased
as thermal underwear, sweaters, Install gaskets behind outlet covers. possibility of fire.
sweatshirts, sweatpants, and socks.
Add plastic sheeting to your windows You can prevent the loss of life and
Set your water heater to the “normal” or purchase plastic window covering property by identifying potential
setting or 120º, unless your kits or interior storm window kits. hazards and following these safety tips:
dishwasher requires a higher setting.
Install a programmable thermostat. Install smoke and carbon monoxide
Open drapes to let the sun heat your alarms in your home.
home during the day and close them at Install low flow showerheads and
night to help insulate. Provide proper venting systems for all
faucets.
heating equipment.
Close off unused rooms and the vents
Wrap your hot water tank with jacket Never use your range or oven to heat
that heat those rooms.
insulation. Be sure to leave the air your home or use a BBQ in your home
Keep warm-air registers, baseboard intake vent uncovered when insulating or garage.
heaters, and radiators clean and make a gas water heater.
sure they’re not blocked by furniture, Place space heaters on level, hard and
carpeting, or drapes. Insulate the water pipes leading from nonflammable surfaces, not on rugs or
your hot water heater. carpets.
Move furniture around so you are
sitting near interior walls instead of Keep space heaters at least three feet
exterior walls and windows. from bedding, drapes, furniture, and
other flammable materials.
Close your fireplace damper tightly
when not in use. Never leave a space heater on when
you go to sleep or leave the area.
Take shorter showers.
Watch children and pets closely in
Wash only full loads in your dishwasher rooms with heating equipment.
and clothes washer.
Always use generators outdoors and
Use cold water when washing clothes. away from doors, windows, and vents..