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  • Main Phone   828-438-6255
    Toll Free   866-427-6452
    Fax   828-433-5721

    Alexander, Burke, Caldwell, Catawba, Gaston,
    Mecklenburg, Rutherford, Stanly, Union

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  • INTRODUCTION & REQUIRED DOCUMENTS


    The mission of the North Carolina Weatherization Assistance Program is to improve household energy efficiency and energy related health and safety, for low-income North Carolina residents. The program focuses primarily on serving the elderly, the disabled, families with young children, high-energy users, and the heavily energy burdened. The Heating and Air Repair and Replacement Program focuses specifically on the repair or replacement of unsafe, inoperable, and inadequate heating and cooling systems. Weatherization assistance is available to low income residents living in single-family houses, apartments, condominiums, and mobile homes. You DO NOT have to own a home to be eligible. Renters MUST have written permission from the property owner before services are rendered. Eligibility criteria may vary between programs. Multifamily units cannot exceed 4 connected units and/or 5 buildings total on property. Each unit must be individually metered.

    What the Weatherization Assistance Program (WAP) and Heating and Air Repair and Replacement Program (HARRP) do:

    • Evaluates homes for energy-related efficiency and safety upgrades 
    • Insulates attics, floors, and walls as needed
    • Makes minor repairs to address energy-related health & safety issues 
    • Repairs or replaces heating/cooling systems if required
  • ELIGIBILITY DOCUMENTATION REQUIREMENTS
    **Provide ALL that apply to each household member. Provide a copy of awards letter or printout for all that apply**


    HOUSEHOLD INCOME DOCUMENTATION


    Income is defined as cash receipts earned and/or received before taxes or deductions. Income includes money, wages and salaries before deductions, regular payments from social security, railroad retirement, and unemployment compensation, strike benefits from union funds, worker’s compensation, veteran’s payments, training stipends, alimony and military family allotments. Private pensions, government employee pensions (including military retirement pay), and regular insurance or annuity payments; dividends, interest, bonds, and other investments (including 1401(k), 403(b), SEP, ESOP, net rental; income, net royalties, periodic receipts from estates or trusts and net gambling or lottery winnings.

    • Government issued photo identification copy (for all adult occupants)
    • Complete Income Tax Returns (including W-2 copies) for all required to file for past year
    • Pay check stubs for last 2-months (including YTD pay) and final check stub from each job ended in last 12-months
    • Unemployment benefits history for last 12-months
    • Proof of Social Security numbers for ALL occupants (i.e., card or printout of number from Social Security office)
    • Social Security Administration benefits history (SSA and SSI) for last 12-months (attach Social Security printout)
    • Veterans Administration benefits history for last 12-months
    • Disability Pension income history for last 12-months
    • Retirement, pension, IRA, dividend, or annuity income history for 12-months
    • Alimony payment history for last 12-months
    • Rental property income history for last 12-months
    • Profit & Loss Statements for all self-employed household members for last 2-years (professionally prepared)
    • Notarized statement for zero-income
    • All other income history for each household member for last 12-months

    DWELLING OWNERSHIP DOCUMENTATION

    • Parcel Tax Record Card issued by the county tax administration within last 30-days
    • Property Tax Notice issued by the county tax administration within last 12-months
    • Deed recorded and stamped at the county court house in the county where the dwelling is located
    • NC DMV issued motor vehicle Certificate of Title for a mobile home or Bill of Sale (exceptions may apply)


    DWELLING FUEL/UTILITY CONSUMPTION HISTORY

    • 12 months fuel/energy history for each fuel/utility provider serving the dwelling (must include kilowatt hours; meter reading date, therms/CCF, number of days in the cycle and billing amount). Printout must include account name and account number.
  • APPLICATION FOR SERVICES

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  • APPLICANT INFORMATION

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  • DWELLING OWNER INFORMATION

  • Click here for Landlord Agreement 

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  • DWELLING AND HOUSEHOLD CHARACTERISTICS

  • Complete applicable sections of the Supplemental Questionnaire for any question below where “YES” is indicated.

  • HEATING SYSTEM

  • AIR CONDITIONING SYSTEM

  • APPLIANCES

  • ELECTRICAL

  • ROOF

  • PLUMBING

  • USE THIS TABLE WHEN ESTIMATING WOOD OR KEROSENE COSTS

    Applicant used wood or Kerosene and did not use a routine vendor for heating for the past 12 months.
  • UTILITY AUTHORIZATION

    Enter account information for all utility accounts (i.e., PNG, Duke Energy, etc.). Account numbers are required.
  • This application authorizes Blue Ridge Community Action, Inc. (BRCA) to verify utility information PROVIDED BY CLIENT in order to qualify applicant for the program and to verify the reduction of energy usage. The information obtained will be kept confidential.

  • HOUSEHOLD DEMOGRAPHIC INFORMATION

    All Occupants MUST be listed & full Social Security number is REQUIRED
  • Family Member 1

  • Family Member 2

  • Family Member 3

  • Family Member 4

  • Family Member 5

  • Family Member 6

  • Family Member 7

  • HOUSEHOLD INCOME INFORMATION

    ALL income earned by ALL Occupants for the last 12 months MUST be listed. One-time distributions should also be listed below . Be sure to list each source of income for each occupant separately.
  • If you are declaring zero income you are required to have a notarized Self-Declaration form which can be found bottom of this page.

  • APPLICATION FOR SERVICES-SUPPLEMENTAL QUESTIONNAIRE

  • PERMISSIONS AND RELEASES

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  • PLEASE READ CAREFULLY

    I, as an applicant for Weatherization and HARRP services, herby authorize the verification of all information provided in the application for service. I further understand that re-verification of my eligibility will take place a minimum of once every 12 months. I agree to notify the service provider should any information provided change prior to receipt of services. I understand and agree that pursuant to federal law, identifying information provided by me for determination of household eligibility for Weatherization and/or HARRP assistance will be considered confidential and, unless otherwise authorized or required by law, will be used only for purposes directly related to administration of the North Carolina Weatherization Assistance Program. I have accepted and understand all Weatherization forms and the Client Education Video (also located on BRCA’s website).

  • PERMISSION TO ENTER PREMISES

    I understand and agree, if approved for services, that I and the members of my household will adhere to the guidelines of the Weatherization Assistance Program; such guidelines may include, but are not limited to, providing BRCA and/or its representatives with ready access to all areas of the dwelling mutually agreed upon times for the purpose of assessment, performing work, and conducting quality assurance inspections of the service provided.

  • PERMISSION TO SHARE INFORMATION WITH COOPERATIVE AGENCIES

    I give BRCA permission to share my information with other agencies in order to coordinate services for the benefit of my household. BRCA may provide cooperative agencies information in an effort to qualify my family for services provided through their agency including but not limited to income, household demographics, photographs taken during the commission of weatherization assessments, and other identifying information in order to assist my family with housing, heating, and/or other home rehabilitation services.

  • MEDIA CONSENT RELEASE

    I hereby consent to participate in interviews, photography, or videos for the purpose of highlighting Blue Ridge Community Action's Weatherization Assistance Program.  This consent grants permission to edit, use and reuse information, photographs or videos in print, broadcast, or other forms of media.  This release applies to all occupants in the home.

  • Application is not complete without Required Documents (Income, Utility Info, Proof of Ownership, etc.)

     

    If you are denied services due to ineligibility, you have sixty (60) calendar days from
    denial to ask for a hearing.

     

      

     

     

     

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  • UTILITY INFORMATION RELEASE AUTHORIZATION

     

    I authorize Blue Ridge Community Action, Inc., the North Carolina Weatherization Assistance Program (“NCWAP”) and its representatives to obtain my household energy usage information from the utility companies listed below for the purpose of tracking my Pre- and Post-Weatherization energy data for the period 12 months prior to the application date {dateOf26}  until the most recent.  I understand that NCWAP is not responsible for the status of my account.

     

    Home Address: {address}

    Contact #:{phoneNumber}

    Email: {email}

     

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