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Weatherization
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Forms
publication content section forms-1293522073
Forms Title
Form
Date
Fuel Switching Request Form
26-031
07/13/2026
WX1 Quality Control Form
21-032
07/13/2026
WX10 - Daily Safety Test Out
21-041
10/29/2025
WX12 - Checklist for Determination of Approval
21-043
10/29/2025
WX13 - Weatherization Client Questionnaire
21-044
10/29/2025
WX14 - Landlord-Tenant Agreement/Permission Form
21-045
10/29/2025
WX15 - United States Citizenship Attestation Form
21-046
10/30/2025
WX16 - Zero Income Verification
21-047
10/30/2025
WX17 - Mechanical System Inspection/Clean & Tune
21-048
10/30/2025
WX18 - Mechanical System Repair/Replacement Bid
21-049
10/30/2025
WX19 - Frame Home Energy Audit Data Collection
21-050
07/13/2026
WX20 - Mobile Home Energy Audit Data Collection
21-051
07/08/2026
WX21 - Completion Service Statement
21-052
10/30/2025
WX22 - Utility Consumption Information Release
21-053
10/30/2025
WX23 - Refrigerator Appliance Agreement
21-054
10/30/2025
WX24 - LIHEAP Heating and Cooling Repair or Replacement Program
21-055
10/30/2025
WX25 - LIHEAP Heating and Cooling Repair or Replacement Bid Form
21-056
10/30/2025
WX26 - LIHEAP Heating and Cooling Repair or Replacement Quality Control Inspection Form
21-057
10/30/2025
WX27 - Equipment Purchase Request
21-058
10/30/2025
WX28 - Request to Remove Items from NeWAP Equipment Inventory
21-059
10/30/2025
WX29 - Request to Remove Items from Weatherization Vehicle Inventory
21-060
08/01/2024
WX3 - Lead Hazard Pre-Renovation Form
21-034
10/30/2025
WX30 - Priority Conditions for Cooling Assistance
21-061
10/30/2025
WX5 - Mold Assessment and Release Form
21-036
10/30/2025
WX6 - Radon Informed Consent/Consent To Perform Work
21-037
10/30/2025
WX7 - Home Health and Safety Screening Questionnaire
21-038
10/30/2025
WX9 - CAZ Depressurization Test
21-040
07/13/2026
