Complete Application Checklist Sample Clauses

Complete Application Checklist. Attached to top of application packet, reflecting information included, Intake Site name and name of person certifying as completed packet of information unless income loss occurred within the last 60 days. DWSS agrees to provide compensation in the amount of $10 for each fully completed Application Packet submitted. DWSS will accept incomplete applications, but no compensation will be provided. DWSS will provide a reason for each Application Packet that is considered incomplete. Attachment C STATE OF NEVADA DIVISION OF WELFARE AND SUPPORTIVE SERVICES ENERGY ASSISTANCE PROGRAM EAP Date Stamp Intake Site Completed Application Checklist Applicant Name: Social Security No.: Date signed by Client: Intake Site: A completed checklist is required to be attached to the top of a completed application packet before it is submitted to the Energy Assistance Program. The Intake Site is responsible for completing the checklist. Refer to the Completed Application Instructions (Attachment B) for a detailed description of each required verification. Intake Site EAP Recv’d Fully completed EAP application Identification of Applicant Citizenship Verification Home/Residence Verification Heating bill/usage Cooling bill/usage Authorization to apply and identification of person Income Other: Other: Signature of Intake Site Staff/Date Signature of EAP Staff/Date Notes: 2886 – EL (10/08) STATE OF NEVADA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF WELFARE AND SUPPORTIVE SERVICES ENERGY ASSISTANCE PROGRAM Attachment D Energy Assistance Program 0000 X. Xxxxxx St., Suite 260 Carson City, Nevada 89706-0246 (000) 000-0000 – FAX: (000) 000-0000 Energy Assistance Program 0000 X. Xxxxxxxx Xx., #00 Xxx Xxxxx, Xxxxxx 00000-0000 (000) 000-0000 – FAX: (000) 000-0000 INTAKE SITE LOG EAP to complete last 2 columns Social Security Number Client Name (Last, First) Alphabetical Order Complete Incomplete Date Sent: Total Number of Applications Sent: Intake Site: Contact Name Person: Name Address Telephone E-mail Address
Sample 1
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Related to Complete Application Checklist

  • Inspection Checklist (check one) ☐ In order to avoid disagreements about the condition of the Premises, at the time of accepting possession of the Premises, Tenant will complete the Inspection Checklist incorporated herein by reference and attached hereto as Exhibit B and record any damage or deficiencies that exist at the commencement of the Term. Landlord will be liable for the cost of any cleaning or repair to correct damages found at the time of the inspection. Tenant will be liable for the cost of any cleaning and/or repair to correct damages found at the end of the Term if not recorded on the inspection checklist, normal wear and tear excepted. ☐ The Tenant is NOT required to complete an inspection checklist.

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