Main utility concern High heating, cooling, electric, gas, or fuel bill Past-due balance or payment plan problem Disconnect notice or shutoff warning Service is already disconnected Home needs energy-saving repairs or weatherization
Household situation Older adult household Disability, chronic condition, or medical device concern Caregiver or adult child is helping with calls Fixed income or recent income drop Not sure which category applies
Energy type to ask about Electricity Natural gas or heating fuel Cooling or air conditioning More than one utility or fuel Not sure
LIHEAP contact status Not contacted yet Looking for the local LIHEAP office Applied and waiting Denied, delayed, or confusing notice
Utility company contact status Not called yet Payment plan or extension discussed Medical or critical-care alert discussed Called, but next step is unclear
Medical device or health risk No power-dependent health need known Oxygen, CPAP, dialysis, powered mobility, or other device Medicine storage or heat/cold health concern Not sure what to ask
Documents today Bills and notices are not gathered Some bills or notices are available Current bill, notice, income proof, and ID documents are organized Important papers are missing
Local backup support No local help contacted yet Area Agency on Aging or 211 contacted Community action or LIHEAP agency contacted Legal aid or consumer help may be needed
Use broad planning answers only.
Do not enter names, addresses, account numbers, Social Security numbers, Medicare or Medicaid numbers, exact income, utility account numbers, medical details, or private benefit information into this worksheet.
This planner is educational and organizational only. It is not legal, financial, benefits, housing, utility, medical, or emergency-response advice. Eligibility, shutoff rules, crisis help, and weatherization programs vary by state, utility, and household facts.
Official references:
USAGov energy bill help ,
HHS LIHEAP ,
LIHEAP local office search ,
USAGov Benefit Finder .
