Community Action Agency of San Mateo
930 Brittan Avenue
San Carlos, CA 94070
650-595-1342

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Contact Us

Information for eligible residents in San Mateo County:

Download Forms

Earthquake Checklist

Asset Development

 1. Low-Income Home Energy Assistance Program (HEAP or LIHEAP)

2. Housing Preservation Grant

3. Home Energy Payment Assistance

4. Emergency Food

5. Healthy Homes Initiative

6. Job Postings

7. Links

8. How We Help

10a. Solicitation for Bids-HVAC

10b. Solicitation for Bids-IT Services

11. Advocacy News

12. Background Info on CSBG

For eligible residents in Santa Clara County:

9. Santa Clara County

9a. Santa Clara County Home Energy Assistance Program (HEAP)

9b. Santa Clara County Weatherization Program

DOWNLOAD HEAP APPLICATION FORMS

Click the form below so you can to print it then fill it out. This page is designed to allow you to download forms without having to wait for them to be mailed or without having to come into our office.

DIRECTIONS: Click on the desired document below. If you click on the document below and the document automatically displays on your screen then click on File and Print (Ctrl+P) to print the document. If you are asked to Open or Save document then you probably do not have Acrobat Reader installed on your computer. Click on Acrobat link below to download and install.

After filling out the forms please mail them to the address below. Do not fax the form because the original signature is required to process the forms.

Energy Intake Form for HEAP Registration

English:

Español:


1. Read this letter.
1. Lea esta letra. 
2. Complete this application form and submit it to us. 2. Complete este formulario de solicitud y nos lo se somete a nosotros.
3. Complete this CSD form and mail it to the address below. 3. Complete este formulario de solicitud y nos lo se somete a nosotros.

Residents of Santa Clara County, click here for HEAP forms.

Mail to:

CAASMC
930 Brittan Avenue
San Carlos, CA 94070
Phone: (650) 595-1342

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Income Eligibility Limits

2010 POVERTY GUIDELINES
 
 # in H/H CSBG
200%*
MONTHLY
 CSBG
  
200%*
YEARLY 
LIHEAP/DOE
75%
State Median
MONTHLY
LIHEAP/DOE
75%
State Median
YEARLY
HPG

YEARLY
HPG

MONTHLY
PG&E CARE
& ENERGY
PARTNERS
MONTHLY
PG&E CARE 
& ENERGY
PARTNERS
YEARLY
 
1  $    1,805.00  $      21,660.00  $       2,482.61  $        29,791.32 $39,800.00 $3,316.67 $2,500.00 $30,500.00
2  $    2,428.33  $      29,140.00  $       3,246.49  $        38,957.88 $45,250.00 $3,770.83 $2,500.00 $30,500.00
3  $    3,051.66  $      36,620.00  $       4,010.37  $        48,124.44 $50,900.00 $4,241.67 $3,000.00 $35,800.00
4  $    3,675.00  $      44,100.00  $       4,774.25  $        57,291.00 $56,550.00 $4,712.50 $3,600.00 $43,200.00
5  $    4,298.33  $      51,580.00  $       5,538.13  $        66,457.56 $61,050.00 $5,087.50 $4,200.00 $50,600.00
6  $    4,921.66  $      59,060.00  $       6,302.01  $        75,624.12 $65,600.00 $5,466.67 $4,800.00 $58,000.00
7  $    5,545.00  $      66,540.00  $       6,445.24  $        77,342.85 $70,100.00 $5,841.67 $5,500.00 $65,400.00
8  $    6,168.33  $      74,020.00  $       6,588.47  $        79,061.58 $75,650.00 $6,304.17 $6,100.00 $72,800.00
9  $    6,791.66  $      81,500.00  $       6,731.69  $        80,780.31 $80,174.00 $6,681.17 $6,700.00 $80,200.00
10  $    7,415.00  $      88,980.00  $       6,874.92  $        82,499.04 $84,698.00 $7,058.17 $7,300.00 $87,600.00
11  $    8,038.33  $      96,460.00  $       7,018.15  $        84,217.77 $89,222.00 $7,435.17 $7,900.00 $95,000.00
12  $    8,661.97  $    103,940.00  $       7,161.38  $        85,936.50 $93,746.00 $7,812.17 $8,500.00 $102,400.00
13  $    9,285.00  $    111,420.00  $       7,304.60  $        87,655.23 $98,270.00 $8,189.17 $9,100.00 $109,500.00
14  $    9,908.33  $    118,900.00  $       7,447.83  $        89,373.96 $102,794.00 $8,566.17 $9,700.00 $116,900.00
15  $  10,531.66  $    126,380.00  $       7,591.06  $        91,092.69 $107,318.00 $8,943.17 $10,400.00 $124,300.00
                   
CSBG- For Families with more than 15 members, add $7480 for each additional member.
*CSBG Poverty Guidelines increased from 100% to 200% effective from July 1, 2009 - September 30, 2010.
LIHEAP/DOE -Annual income amounts for greater than 15 members,  add 3% for every household over 15 persons
HPG - Add 8% of 4 person limit for each person in excess of 8.
PG&E CARE & Energy Partners - Add $7,140 for each person in excess of 15.
For additional information, please contact: Community Action Agency of San Mateo County, Inc.
     930 Brittan Avenue
     San Carlos, CA  94070

     Phone: 650-595-1342

Revised 2-2-10

Download Employment Application Form

Click here for the Employment Application.

 

Download Application form for Board of Directors

Click here.

 


[Home]      [Board of Directors]     [Board Meetings]     [Contact Us]     [Download Forms]     [Earthquake Checklist]

[1-LIHEAP/DOE]     [2-Housing Preservation Grant]     [3-Home Energy Payment Assistance]     [4-Emergency Food]

[5-Healthy Homes Initiative]     [6-Job Postings]     [7-Links]     [8-How We Help]

[9-Santa Clara County]   [9a-Santa Clara County Home Energy Assistance Program]   [9b-Santa Clara County Weatherization Program]

     [10a-Solicitation for Bids-HVAC]    [10b-Solicitation for Bids-IT]    [11-Advocacy News]  

  [12-Background Information on Community Services Block Grant (CSBG)]

Send mail to teresa@cencomfut.com with questions or comments about this web site.
Copyright © 2010 Community Action Agency of San Mateo County, Inc.
This web site was last modified: Tuesday March 09, 2010 at 12:05 p.m. Pacific Time