PUD No. 2 of Pacific County works with Bonneville Power Administration (BPA) to provide the ability to apply for the Low- Income Weatherization Program by filing an application. Applicants approved for the program shall receive an increased incentive on programs for insulation, window replacement, and ductless heat pumps. The Total Household Income levels will be adjusted each year in December based on the United States Department of Health and Human Services Federal Poverty Guidelines for the ensuing year's program. Household income must fall under 200% of the Federal Poverty Guidelines. Please complete the Income Worksheet and provide a copy of your most recent federal tax return to verify eligibility.

I hereby certify that the provided information is true and correct to the best of my knowledge and represents income for all household members. I understand that I am signing this form under penalty of perjury if I knowingly provide false information which results in a payment I am not entitled to.

"Total Household Income" means the total of all sources of income/monies received by every household member. A copy of each occupant's most recent federal tax return is required. If a tax return is not filed, please submit supporting documents for each amount listed below. Please give the total amount for each item in a 12-month period.