SFN 1059, Authorization for Release of Information 415-65-40
(Revised 12/1/03 ML #2895)
This form is available through the Department of Human Services and may also be obtained electronically via E-Forms.
Energy Assistance Policy Manual - 415
PROGRAM OWNER: LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP)
Published by Economic Assistance (EA)
(Revised 12/1/03 ML #2895)
This form is available through the Department of Human Services and may also be obtained electronically via E-Forms.