The Warm Heart Program is an energy assistance program undertaken by PUD No. 2 of Pacific County to reduce the household energy burden of its customers. The program is funded through voluntary PUD customer donations and administered by Crisis Support Network (CSN).

RCW 19.405.120 (Washington Clean Energy Transformation Act). This program is structured in compliance with Washington's Clean Energy Transformation Act
(CETA), which directs electric utilities to make energy assistance available to low-income households. Key definitions and priority criteria:

• "Energy burden" means the share of annual household income used to pay annual home
  energy bills. A household earning $30,000/year and paying $1,800 or more annually in
  energy costs has an energy burden of 6% or greater.
• "Energy assistance" means a program undertaken by a utility to reduce the household
  energy burden of its customers.
• Priority: When program funding is limited, households with an energy burden of 6% or
  greater will receive priority for assistance, consistent with RCW 19.405.120.

1. Applicants must be a PUD customer with an account in their name. Eligible accounts include active accounts, accounts with an outstanding balance, and accounts disconnected for non-payment within the last 14 days where the customer is currently paying reconnect charges.

2. Household income must be at or below 200% of the Federal Poverty Level (FPL) or 80% of the Area Median Income (AMI), whichever is greater. Income thresholds are updated annually by the PUD Customer Service Manager. Proof of all sources of income for all household members is required.

3. Assistance may be applied toward electric service charges, electric service deposits, or water service charges. Water service assistance is only available when provided alongside an outstanding electric account balance.

4. If assistance is used toward a deposit, the applicant agrees by signing this application, that the deposit will be refunded to the Warm Heart Program upon account closure.

5. Any balance exceeding the $300.00 annual maximum remains the responsibility of the applicant.

6. Assistance is limited to once per 12-month period per household.

7. All required documentation must be submitted to CSN before eligibility can be determined. Original signatures are required on all application documents.

Eligibility will not be determined until ALL required documentation has been provided to Crisis Support Network. Any missing documents will delay processing of this application.

1. Most recent PUD statement showing: (1) applicant's name as an account holder, (2) PUD account number, (3) total amount due.

2. Complete list of all household members (below)

3. Total household income for ALL household members.

• Pay Stubs - showing previous 2-months of income
• IRS Form 1040 (Schedule A) - showing total gross household income for previous calendar year
• Section 8 Eligibility*
• HUD Eligability*
• Proof of current assistance from a state health or human service agency
• Certification from Coastal Community Action/LIHEAP Administrator *
• SSI Award Letter
• Current TANF Benefits

*Customers showing proof of Section 8 eligibility, HUD eligibility, or certification from Community Action Agency/LIHEAP Administrator automatically qualify for the Warm Heart Program, and are not required to provide proof of income.

I certify that the information contained in this application is complete and accurate to the best of my knowledge. I understand that I am signing this application under penalty of criminal prosecution if I knowingly provide false information which results in assistance for which I am not eligible. I authorize CSN to release only such information as may be required to deliver the requested assistance, and to contact any person or agency named in this application for verification purposes.

It is the policy of Crisis Support Network (CSN) that no person who otherwise meets eligibility requirements shall be subjected to discrimination in the delivery of service by this agency because of race, color, redigion, disability, pregnancy, national origin, sexual orientation, gender, age, ge, ethnicity, income, status, marital status, or any other basis prohibited by federal, state or local law,

Upon execution of this agreement by both the applicantand authorized CSN staff, CSN will remit the Warm Heart Program benefit amount directly to the PUD on behalf of the applicant. Disbursement is contingent upon CSN's receipt of all required documentation, which must satisfy applicable contract criteria prior to approval.

By signing below, the applicant acknowledges that any electric service deposits covered by the Warm Heart Program are to be returned to the Warm Heart Program upon closure of the account.

For inquiries regarding the status of this application, applicants may contact CSN at 1-800-435-7276.

It is the policy of Crisis Support Network (CSN) that no person who otherwise meets eligibility requirements shall be subjected to discrimination in the delivery of service by this agency because of race, color, redigion, disability, pregnancy, national origin, sexual orientation, gender, age, ethnicity, income, status, marital status, or any other basis prohibited by federal, state or local law,