Income Guidelines & Forms

For more information about Energy Programs provided by the state of Minnesota please visitĀ www.energy.mn.gov.

2014 – 2015 Energy Assistance Application

English Forms:
Change of Address 2013-2014
County Assistance Release 2013-2014
Direct Spousal Support Release 2013-2014
Disability Verification Release 2013-2014
Employer Release 2013-2014
Gift Loan Statement 2013-2014
Interst & Dividend Release 2013-2014
Out of State Unemployment Release 2013-2014
Pension Release 2013-2014
Tribal Income Release 2013-2014
Verification of Income and Expenses 2013-2014
Veterans Benefits Release 2013-2014
Work for Rent Release 2013-2014

Spanish Forms:
County Assistance Release – SPANISH 2013-2014
Disability Income Release – SPANISH 2013-2014
Employer Release – SPANISH 2013-2014
Work for Rent – SPANISH 2013-2014

2014/2015 Income Guidelines:

2014 Maximum Energy Assistance Program Income GuidelinesĀ  2015 Maximum Energy Assistance Program Income Guidelines
Based on 50% SMI or 110%* of federal poverty guidelines, whichever is greater
Household Size Annual Income 3 month Maximum Guidelines Household Size Annual Income 3 month Maximum Guidelines
1 $23,354 $5,838 11 $66,021 $16,505
2 $30,540 $7,635 12 $67,368 $16,842
3 $37,726 $9,431 13 $68,715 $17,178
4 $44,912 $11,228 14 $70,895 $17,723
5 $52,098 $13,024 15* $75,361 $18,840
6 $59,284 $14,821 16* $79,827 $19,956
7 $60,631 $15,157 17* $84,293 $21,073
8 $61,979 $15,494 18* $88,759 $22,189
9 $63,326 $15,831 19* $93,225 $23,306
10 $64,673 $16,168 20* $97,691 $24,422

 

 

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