You Thrive Florida Community Services Application for Assistance

READ THESE INSTRUCTIONS AND DIRECTIONS BEFORE COMPLETING YOUR APPLICATION:

Provide all documents required:

 Photo ID (Government Issued) cannot be expired over 1 year 

  • Driver’s License for all household members 18 years of age and older
  • Birth Certificates for children 17 years of age and under

 Social Security Cards: (Applicant’s must be signed) for everyone living in the home 

  • Crib cards allowed ONLY for newborns and up to 3 months
  • MEDICARE CARD

 Income information:  Including SSI/Disability award letter; If disabled, we require verification; most recent pay stubs (last 30 days), unemployment or retirement, child support, If TANF, the award amount needs to be on the letter, etc. 

 Original Electric Bill:  We need the original electric bill showing the wattage usage for every month that needs paid.  

 Food Stamps: Current Award Letter or a Denial Letter with everyone’s name listed in the household. If applying or reapplying a print out of the finished application. 

 Lease/Rental Agreement: Required for deposit or reconnect. Must be current and signed by the landlord and tenant (s) with the landlord’s phone number and address. All household members listed on the lease. 

 Deposits require information from electric company with current address and account number or request a fee sheet to be sent.

 Section 8, Hud Housing or Rural Development we need either a referral or lease from housing, Tenant Computation Worksheet (TTP form) letter showing utility allowance. 

BE ADVISED;
Only apply for the county in which you live. If you apply under another county, your application will not be accepted.
We are no longer accepting applications by mail or drop off.
Once applications have reached capacity, we will not accept any more, either on-line or by appointment, until we have processed the applications we have on hand.
Applications will be processed in the order they are received.
Applications can take up to two weeks to process once all documents are received and the application is filled out completely. A staff member will provide updates as we review for processing.
Once your benefit is complete, a voucher will be sent to the utility provider and it will be applied to your account. Payment will be processed within 45 days according to our agreement with the utility provider.
White-out and scribbles will not be accepted on applications.
If the electric bill is in the name of someone not in the household, we need a letter from the account holder stating WHY the electric bill is in their name. They must sign it, provide their address, phone number, and their date of birth.

I have read the conditions of applying for energy assistance with You Thrive Florida. I will comply with providing all documentation and information needed, understanding that if I do not supply all required information, my application will not be processed. *
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Highest Education Level *
Ethnicity *
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Food Stamps:
Housing Status *
 
Public Housing (section 8, HUD, Low Income/USDA) *
Rent Subsidy? *
Utility Allowance? *
Does anyone in your household live in a dormitory, nursing home, adult foster home, or any kind of group living facility?
Are any household members: (select all that apply) *
Was client referred to the local Veteran's Affairs office?
Are you or any member of your household a member of the Poarch Creek Indian Tribe?
Your primary source of energy. *
 
Provide the following information about the primary source of energy you use to cool or heat your home.
If you, or any member of your household, has received energy assistance in the current season, complete the information below:
 Name of AgencyType of Help (elderly, crisis)Date
Provide
WAP REFERRAL: If the applicant is a homeowner, has he/she received more than three LIHEAP or EHEAEP benefit in the last 18 months?
If the answer to the previous question is 'yes', was the applicant referred to WAP?
Are you, any member of your family, or any of your household members an employee of You Thrive Florida? *
Fraud Statement: The information above is, to the best of my knowledge, true and complete. I understand that priority in providing assistance will be given to those households with the lowest income and greatest need, i.e., those households in which the elderly, disabled, medically needy, or children under the age of 5 reside. I authorize the agency to make benefit payments directly to my energy supplier. I am aware that after I have provided all the information requested, if I am applying for crisis assistance, the agency has 48 hours; 18 hours if my situation is life threatening, to approve or deny my application, and, if I am applying for Home Energy Assistance, the agency has 45 days to approve or deny my application. I am also aware that if I am not approved or denied within the time allowed, or not apprvoed for the correct amount, I have a right to an appeals hearing.
 
Acceptance of Application to You Thrive Florida: I certify that the guidelines have been explained to me and that I waive the provisions for the privacy act to allow You Thrive Florida to verify income eligibility. I further certify that all information on this application is true and correct.
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Applicant Signature *
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