The Leap application IML-4 form is a crucial document used in various administrative processes, designed to streamline applications and ensure compliance with necessary regulations. Understanding its purpose and how to fill it out accurately can significantly enhance your chances of success. Ready to get started? Fill out the form by clicking the button below.
The Leap application IML-4 form plays a crucial role in the process of applying for various benefits and services. Designed for individuals seeking assistance, this form streamlines the application process by collecting essential information about the applicant's circumstances. It includes sections for personal details, income verification, and specific needs related to the services requested. The form also prompts applicants to provide documentation that supports their claims, ensuring that the review process is thorough and efficient. By adhering to the guidelines set forth in the IML-4, applicants can enhance their chances of receiving the help they require. Understanding the components of this form is vital for anyone looking to navigate the application process successfully.
COMPLETE ALL
APPLICATION FORM 4 PAGES AND
(Program Year is November 1stApril 30th)
SIGN PAGE 4
F O R C O U N T Y U S E O N L Y
Basic
Notes
Date Received
1. APPLICANT
If you need assistance in completing this application, call HEAT HELP at 1-866-432-8435.
Last Name
First Name
Middle Name
Address of Residence
City
State
Zip Code
Mailing Address (If Different Than Residence)
Male
U.S. citizen?
non-citizen?
Female
Other
Yes No
Email Address
In which county do you live?
Social Security Number
Information reported in this section will not be used to determine your eligibility for LEAP or your payment level. This information will only be used for statistical information.
Check ( ) here if any member of your household is:
Disabled or a Veteran
Ethnicity of applicant:
Hispanic (HS) Non-Hispanic (NHS)
Race of applicant:
White/Caucasian (WC)
Black or African American (B or AA) American Indian or Alaska Native (AI or AN)
Asian (AS)
Other/Unknown (OTH)
2. OTHER HOUSEHOLD MEMBERS
Complete the following for any other members of your household. Your household means the people who live with you for whom you have
Name
(List all household members)
Social Security
Number
Date of
Relationship
Birth
to You
Age Sex
Place of
Ethnicity
Race
Are you
*Are you a
(see
a U.S.
documented
above
citizen?
for code)
for
code)
*If you or members of your household are a registered non-citizen, PLEASE ATTACH A COPY OF YOUR DOCUMENTED NON-CITIZEN VERIFICATION TO THE APPLICATION.
IML4 (R 7/23) IDS/NB
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615-82-10-4008
3. DOES ANYONE ELSE LIVE AT THIS ADDRESS? Yes No
If yes, how many? ______.
Relationship to You
Age
4. HOUSEHOLD INCOME
A. Do you or anyone in your household have work income? Yes No
Who Receives It?
How Often Paid?
Gross Monthly
Amount
Employer Name
Attach copies of pay stubs for at least the 4 weeks prior to the date of application.
B.Do you or anyone in your household have self-employment work income? (Includes baby sitting, etc.) Yes No
Is this an LLC
or SCORP?
Yes
No
If you have business
expenses, please attach
copies of receipts.
C.Do you or anyone in your household have non-work income (which includes any public assistance programs) as listed below? Yes No Social Security income (SSA); Supplemental Security Income (SSI); Supplemental Security Disability Income (SSDI); Colorado Works (TANF);
Type of Non-Work Income
as Listed Above
Attach copies of award
letters for the month previous to your date of application.
D. Yes No If Yes, provide a loan repayment schedule. If a loan, what date did you receive the money? ___________________________ How much is the total loan? _____________________
What date do you begin repaying the loan? ____________________________ How much money per month?______________________
If a gift(s) from a friend or relative, what date did you receive the money? _________________ How much was the gift? ______________
E.
Rent:________________________________________________
Utilities: _______________________________________________
COMPLETE ALL 4 PAGES AND SIGN PAGE 4. PLEASE RETURN ALL 4 PAGES.
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5. LIVING ARRANGEMENTS
Check ( ) the item that best describes the dwelling where you currently live and are applying for assistance.
House/Modular Home
Rooming/Boarding House
Fraternity or Sorority House
Cabin
Hotel/Motel
Rehabilitation Center
Camper
Townhouse
Car/Van/Bus
Correctional Facility
5th Wheel
Apartment/Condominium
Group Home
Nursing Home/Residential Care Facility
RV
Mobile Home
Dormitory
Other Dwelling, Please Specify: ___________________
Do you rent? Yes. If yes, what is your monthly rent? $ ______________________
Do you have a mortgage payment? Yes.
If yes, what is the monthly mortgage payment? $ ____________________; or, do you own your dwelling outright? Yes
Do you pay a lot or space rental amount? Yes. If yes, what is your monthly space rent payment? $ ___________________
What is the name and phone number of your apartment complex or landlord? _____________________________________________
6. SUBSIDIZED HOUSING
Do you live in Section 8, public housing, or do you receive a subsidy to pay your rent? Yes No
7. HEAT/RENT INFORMATION
ARE YOU HAVING AN EMERGENCY WITH YOUR PRIMARY HEATING FUEL RIGHT NOW? Yes
If yes, check type of emergency below and attach a copy of the notice from your energy provider:
Already disconnected. Disconnect Date: ____________________
Received disconnect notice but not yet disconnected. Date disconnect scheduled: ____________________
Propane tank empty or are you out of a bulk fuel such as wood, fuel oil, etc.? Amount needed for minimum delivery: $ ______________
Propane tank at 20% or below. Amount needed for minimum delivery: $ ___________________
Check () the main fuel used to heat (not light) your residence. CHECK ONLY ONE.
Natural Gas Propane Electricity Wood Coal Fuel Oil Kerosene Other: ________________________________
Check () the way in which the heat (not light) is paid for at your residence.
I pay heating costs directly to a utility company or fuel dealer. (If so, attach copy of most recent heating bill).
Name of fuel provider: _____________________________________ Billing account number: _____________________________________
If your electricity is supplied by a different company, please provide:
Electric company name:_________________________________________ Account number: _____________________________________
Name: ______________________________ Address: _________________________________________ Relationship: ________________
______________________________________________________________________________
Heat is included in my rent. (If so, attach a copy of the most recent rent receipt that already shows heat is included.)
Someone other than a member of my household pays my heating costs.
Provide name and address of that person and their relationship to you.
Name: ______________________________ Address: _________________________________________ Relationship: _____________
_________________________________________________________________________________
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8. ADDITIONAL INFORMATION
I learned about LEAP from the following source (check only one):
Friend
1-866-HEAT-HELP (432-8435)
Senior Center
LEAP Poster
Newspaper
Billboard
PEAK Website
Heating Company
Radio
Bus Benches
Received Application in Mail
LEAP Website
Television
9. CONSENT TO DISCLOSE CUSTOMER DATA
1 Heat Help Line: (866) 432-8435
Your utility account payment history and other account details, such as utility charges, payment history, past due amounts, pending deposits, current shut-off due dates or disconnection, current life support status, payment arrangements, and history of energy assistance payments.
information that is collected from your Electric Natural Gas utility meter by your utility service provider.
programs. If you authorize the disclosure, it will start on the date you sign this application and end when you terminate your participation in the relevant energy assistance program. You have a right to receive a copy of this form.
Please note that:
You are not required to authorize your utility service provider to disclose your customer data.
Your decision not to authorize the disclosure will not affect your utility services.
perform services on behalf of the utility, or (3) as otherwise permitted or required by laws or regulations.
Your utility service provider will have no control over the data disclosed pursuant to this consent, and will not be responsible for monitoring
1
10. SIGNATURE AND CONSENT
By signing below I understand, I acknowledge and agree that:
3. The Colorado Department of Human Services (CDHS) may use my Social Security Number to get wage data, amount of unearned income, child
6. If LEAP repairs or replaces my heating system and I refuse to allow access to my dwelling for the purposes of completing the service
and permanently following a third offense.
S I G N F U L L N A M E B E L O W
Signature: __________________________________________________________
Date:________________
If someone helped the applicant complete this application, such person must sign below.
_____________________________________________
_____________________________________
Signature of Helper
Print Name of Helper
_________________________________________________
___________________________
_______________
If you would like to know the status of your application please call HEAT HELP at 1-866-432-8435.
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Completed
Filling out the Leap application IML-4 form can seem daunting at first, but with the right guidance, you can navigate through it with ease. Once you complete the form, it will be submitted for processing, and you'll be one step closer to your goal. Here’s how to fill it out effectively.
What is the Leap application IML-4 form?
The Leap application IML-4 form is a specific document used for applications related to the Leap program. This form collects essential information from applicants to determine eligibility and facilitate the application process. It is important for applicants to complete this form accurately to ensure timely processing of their requests.
Who needs to fill out the IML-4 form?
Individuals interested in applying for the Leap program must fill out the IML-4 form. This includes anyone seeking assistance or benefits provided under the program. It is crucial that all applicants provide the necessary information to support their case.
How do I submit the IML-4 form?
The IML-4 form can typically be submitted online through the Leap program's official website. Alternatively, applicants may also have the option to print the form and mail it to the designated address. Be sure to check the specific submission guidelines provided by the program to avoid any delays.
What information is required on the IML-4 form?
The IML-4 form generally requires personal information such as name, address, contact details, and relevant background information related to the application. Applicants should ensure that all sections are completed thoroughly to prevent processing issues.
Is there a deadline for submitting the IML-4 form?
Yes, there is usually a deadline for submitting the IML-4 form, which can vary depending on the specific program cycle. It is advisable to check the Leap program’s official communications for the most accurate and up-to-date information regarding deadlines.
What happens after I submit the IML-4 form?
Once the IML-4 form is submitted, it will undergo a review process. The program staff will evaluate the application based on the provided information. Applicants may receive notifications regarding the status of their application or any additional steps needed.
Can I make changes to my IML-4 form after submission?
In most cases, once the IML-4 form is submitted, changes may not be allowed. However, if you realize that you need to make a correction, it is best to contact the Leap program directly for guidance on how to proceed. They can provide specific instructions based on your situation.
Completing the Leap application IML-4 form can be a straightforward process, but many applicants make common mistakes that can lead to delays or even denials. One frequent error is not providing accurate personal information. Applicants sometimes transpose numbers in their Social Security numbers or misspell their names. This can create confusion and complicate the processing of the application.
Another mistake involves leaving sections of the form blank. Every question on the IML-4 form is there for a reason. Omitting information can raise red flags and result in a request for additional documentation. It’s essential to read each question carefully and provide complete answers to avoid unnecessary delays.
Many people also fail to double-check their application for errors. Simple typos or incorrect information can be easily overlooked. Taking the time to review the completed form before submission can prevent these small mistakes from becoming major issues.
In addition, some applicants do not provide the necessary supporting documentation. Each application typically requires specific documents to verify the information provided. Failing to include these documents can lead to a rejection of the application or a request for further information.
Another common pitfall is not adhering to the submission guidelines. Each form has specific instructions regarding how and where to submit it. Some applicants mistakenly send their forms to the wrong address or use an incorrect method of submission, which can delay the processing time significantly.
Moreover, individuals often underestimate the importance of signatures. Forgetting to sign the form or providing an incomplete signature can invalidate the application. It is crucial to ensure that every required signature is present and correctly executed.
Additionally, applicants sometimes submit their forms too close to deadlines. Procrastination can lead to rushed submissions, which increases the likelihood of mistakes. Planning ahead and allowing ample time for completion can help mitigate this risk.
Lastly, many people overlook the importance of keeping a copy of the submitted application. Without a record of what was submitted, it can be challenging to follow up or address any issues that arise. Keeping a copy ensures that applicants have a reference point for future communications regarding their application.
The Leap application IML-4 form is an essential document for individuals seeking specific assistance or benefits. To support your application, several additional forms and documents may be required. Each of these documents plays a crucial role in providing the necessary information and context for your application. Below is a list of commonly used forms and documents that may accompany the IML-4 form.
Gathering these documents in advance can help streamline the application process and ensure that your submission is complete. Each document serves to paint a clearer picture of your circumstances, enhancing the likelihood of a favorable outcome.
The Leap application IML-4 form shares similarities with several other documents used in various applications. Here are four such documents and how they relate to the IML-4 form:
When filling out the Leap application IML-4 form, attention to detail is crucial. Here are some essential dos and don'ts to keep in mind:
Here are nine common misconceptions about the Leap application IML-4 form, along with explanations to clarify each point:
This form is designed for a wide range of applications, not limited to specific categories. It serves various purposes depending on the applicant's needs.
While understanding the requirements is beneficial, anyone can complete the form with the right guidance. Clear instructions are provided to assist applicants.
This form can be used by organizations as well. Both individuals and entities can submit applications using the IML-4.
Supporting documents are often required to validate the information provided. Submissions without these documents may lead to delays or rejections.
Applicants can request amendments to their submissions if necessary. However, it's important to follow the proper procedures for making changes.
Submission of the form does not guarantee that the application will be approved. Each application is reviewed on its own merits.
Fees may vary depending on the specific circumstances of the application. Some submissions might not require a fee at all.
Each form has its own purpose and requirements. The IML-4 form is unique and should be treated as such.
Applicants typically receive updates regarding their application status. Communication is an important part of the process.
The Leap application IML-4 form is an important document for various processes. Below are key takeaways regarding its completion and use.
Following these guidelines can help ensure a smoother experience with the Leap application IML-4 form.