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Division of Welfare and Supportive Services
ENERGY ASSISTANCE PROGRAM
NOTICE OF RIGHTS AND OBLIGATIONS
**** PLEASE READ AND SIGN BELOW ****
A. You have the following RIGHTS:
1. No person will be discriminated against for any reason, i.e., race, age, color, religion, sex, disability, handicap (including
AIDS and AIDS related conditions), political belief or national origin, in any program administered by the Division of
Welfare and Supportive Services. When the Energy Assistance Program (EAP) pays another agency, institution or person
to provide EAP services to a household, the vender is not permitted to discriminate for any reason. Violations of
discrimination shall be promptly reported to the Energy Assistance Program office, the Division of Welfare and Supportive
Services Administrator, 1470 College Parkway, Carson City, Nevada 89706-7924, (775) 684-0500, the U.S. Office for
Civil Rights (OCR), Department of Health and Human Services, 50 United Nations Plaza, San Francisco, California 94102,
(415) 437-8310, TDD (415) 437-8311 or by calling toll free 1-800-368-1019.
2. You have the right to a conference if you believe you have been unfairly treated or a mistake has been made concerning
your eligibility for assistance. To request a conference, write or call the Energy Assistance Program.
3. You have the right to a hearing if you are not satisfied with the agency’s action affecting your assistance if you request the
hearing, in writing, within ninety (90) days of the agency’s action/decision, unless the sole issue for the agency’s
action/decision is one of state or federal law requiring automatic benefit adjustment. You have the right to a hearing if your
application for benefits is denied, reduced, acted upon erroneously, or not acted upon with reasonable promptness.
4. You have the right to a mailed notice of decision telling you if you are eligible for program benefits and in what amount, to
whom payments will be made, and the approximate payment date(s); or a notice informing you that you are not eligible for
program benefits and why.
5. Program staff is required to:
● Inform applicants of the eligibility requirements for the program;
● Counsel on required documents; and/or
● Provide assistance to the applicant when needed.
B. You have the following OBLIGATIONS:
1. Notify the Energy Assistance Program within ten (10) days of any of the following. Failure to do so may delay processing
your application, or result in denial of benefits or a reduction in benefits.
● Any change in your household income or household size (number of people residing in the household);
● If you change utility companies; or
● If you move anytime after submitting your application.
2. Respond to any requests for additional information needed to process your application within ten (10) days. It is your
responsibility to ensure the requested materials are mailed or faxed early enough to meet the deadline provided to you. The
Energy Assistance Program is not responsible for lost or misdirected mail, or faxes. (Be sure your name and SSN or UPI
are on all documents/correspondence.)
3. Cooperate with the Energy Assistance Program in its efforts to secure all information necessary to determine eligibility or
benefits.
C. SPECIAL NOTE:
1. If you are applying for the Energy Assistance Program, you may receive help with your heating and/or electric bills. BUT
REMEMBER, YOU MUST KEEP PAYING YOUR BILLS WHEN THEY ARE DUE. If you do not pay them, the
company can charge more money for paying late. The utility company can even turn off your service and you may be
required to pay a deposit before they will turn your service on again. If you cannot pay your bill, contact the utility
company and try to make payment arrangements.
2. Persons found guilty of intentionally violating program rules will be ineligible for program participation for one (1) year
for the first violation, two (2) years for the second violation, and permanently barred from the program for the third
violation.
My signature below indicates I understand the Rights and Obligations as an applicant for the Energy Assistance Program.
Print Name of Applicant/Recipient:
Signature of Applicant/Recipient: