ACTION-Housing Weatherization Assistance Program Referrals

If your household is in Allegheny, Washington or Greene Counties, and has not been weatherized in the last 15 years, and meets the income guidelines to the right, please complete this application request form.

* Indicates required information
First Name*
Last Name*
Organization
Title
E-mail address
Phone*
Address*
Address #2
City *
State*
Zip*
How did you hear about us?

Have you received LIHEAP in the last 12 months?
Yes No
If qualified, you can expect to receive an application in the mail within 2 weeks.

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Income Guidelines

All income must be totaled by *GROSS amount received* (before taxes or deductions)

Persons	200% of poverty (Annual Income)
1	$22,340
2	$30,260
3	$38,180
4	$46,100
5	$54,020
6	$61,940
7	$69,860
8	$77,780
each additional person	$7,920

For each additional member, add $7,920 200% of Federal Poverty Guidelines.

EFFECTIVE 02/04/2011.* Income Guidelines are subject to change

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