Dear Consumers Energy Customer, You recently received a letter from Consumers Energy introducing the Consumers Energy Affordable Resource for Energy (CARE) program. You contacted The Heat and Warmth Fund (THAW) to express interest in enrollment. THAW is hosting CARE enrollment events in Pontiac, Southfield, Saginaw and Warren. You can call 248-877-2818 to schedule an appointment or you can submit the enclosed application to THAW by mail. Please follow CARE application instructions carefully. Supporting documentation is required. This application packet must be received by THAW on or before January 24, 2014. Mail to: The Heat and Warmth Fund Attn: CARE 607 Shelby, Suite 400 Detroit, MI 48226 Please contact THAW at 866-281-0031, If you have any questions regarding this process. Sincerely, The THAW Team
7.7 8.5 3.6 1 0 0 0 0 0 Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2012 2013 05 CLPBAL 06/13 Include Corrections/Comments on Back Reminder- Previous balance was due 05/30/13. Please pay the past-due amount to avoid credit action. Thank you. Payments applied after Jun 06, 2013 are not included. Your next scheduled meter read date is on or around 07/05/2013. Your payment is due July 01,2013. After the due date, the unpaid balance is subject to a 2% late payment charge. Thank you for taking the time to apply for the Consumers Energy Affordable Resource for Energy Program (CARE). Below are the following steps to take to ensure you have the proper paperwork and documentation to apply. Your information must be received by THAW by January 24th, 2014. Incomplete applications will not be processed. DOCUMENT CHECKLIST - Copy of your Michigan drivers license or Michigan State ID - Consumers Energy Bill - Current proof of Income Statement for any person in the household receiving income Paycheck Stub SSI Statement Social Security Statement TANF Statement Natural Gas Safety and Reliability. We are committed to providing safe, reliable natural gas service while protecting the health and safety of our neighbors who live or work near our pipelines and facilities. Get safety tips and learn what to do in an emergency at www.consumersenergy.com/gascenter. In case of an emergency, call us immediately day or night at 1-800-477-5050. LANSING, MI 48937-0001 MICHAEL J JACKSON 4278 BERKSHIRE DR Account Number: 1030 0352 2929 STERLING HEIGHTS MI 48314-1201 Due: 07/01/13 Enclosed: Detail of Current Charges Gas Residential Service Rate: 250 Thousand cubic feet used: 3.6 Mcf Meter reading: 747-783 (actual) Meter Number: 25569144 POD: 0000003388522 Differential: 36 Constant: 0.1 Correction factor: 1.00000 Gas Charges Customer Charge $10.50 Gas Distribution 3.6 @ 2.605400 $9.38 Energy Efficiency 3.6 @ 0.303000 $1.09 Gas Cost Recovery 3.6 @ 4.793700 $17.26 Total Gas $38.23 13 14.6 15.8 14.1 June Gas use 3.6 Mcf Gas use per day 0.124 Mcf Gas cost per day $1.32 Total: $779.95 Summary of Charges Account Number: 1030 0352 2929 Service: MICHAEL JACKSON 4278 BERKSHIRE DR STERLING HEIGHTS MI 48314-1201 Balance Forward $690.04 Late Payment Charge $20.15 Total Gas $38.23 Sales Tax $1.53 Total Energy Charges $39.76 Return Fee $15.00 Return Fee $15.00 Total Amount Due $779.95 Cash/Money Order Only Billing Period 05/07/13-06/04/13 Bill Month June Days Billed 29 Invoice 205541370523 News You Can Use The average residential customer is expected to save $3.54 each month over the life of the Energy Efficiency programs. Authorized Pay Agents. Kmart and Walmart are now among the authorized merchants throughout Michigan that accept payments on behalf of Consumers Energy. For sites near you, visit www.consumersenergy.com and choose "Payment Options." For your safety, DO NOT USE UNAUTHORIZED PAYMENT CENTERS. For more than 100 ways to save on your energy bill, visit www.consumersenergy.com/energyanswers. Complete the 8 question EASE Survey (included). We ask that you make your best guess in answering the questions, even if you are unsure of the answers to the questions. EASE Survey CARE (Consumers Affordable Resource for Energy) Making Energy More Affordable What You ll Get What You ll Give A 40% discount on your bill till August 2014 Make on-time monthly payments toward a more Here s an example, if your bill was $100: affordable bill. $100 Total Energy -$40 CARE Credit =$60 You Pay Visit: www.consumersenergy.com Call us: (800) 477-5050 Read and sign the bottom of the form that has the two columns on it called, What you ll get and What you ll give An online survey tool about Energy Use called Complete initial EASE survey with your EASE (Everyday Actions Save Energy) that provides caseworker and, if you wish, log in again on your a home report with easy tips on energy savings. own to take a second survey for more tips. Invitation to have an Energy Expert visit your Talk about and set 3 energy savings goals with the home for free through a program called Helping energy expert simple steps you can take around Neighbors. Depending upon your home s the house to use less energy and save even more condition, you may receive: on your bill. Water heating & lighting measures Carbon monoxide test Air sealing Furnace tune-up Insulation A friendly Agency Caseworker, who will help you While on CARE, understand that you cannot: understand the CARE program and is someone you Apply for State Emergency Relief (SER) can call if you have questions or need extra energy benefit from DHS for your support. Consumers Energy service Be on any other Consumers Energy payment plan at the same time as CARE Agency: Make payment arrangements on any pastdue balance Phone number: If you cannot pay your bill by the due date, you will If you are removed from CARE due to nonpayment, you cannot: receive a courtesy Past-Due Reminder call 11 days following. This call is a warning that, unless Re-enroll in CARE payment is received within one week, you will be Enroll in the Shut-Off Protection Plan (SPP) removed from CARE. until September 2014 Apply for State Emergency Relief (SER) If you are removed from CARE, you can: energy benefit from DHS for your Make payment arrangements on the pastdue balance Consumers Energy service until Oct. 2014 Enroll in the Winter Protection Plan (WPP) I understand and agree to enroll (sign/date): / APPLICATION Complete and sign the CARE application x Mail your application, documentation, What you ll get/what you ll give form, and EASE Survey to: The Heat and Warmth Fund ATTN: CARE 607 Shelby, Suite 400 Detroit, MI 48226 If you are eligible for the CARE program you will receive a CARE welcome packet from THAW within 30 days. If you have any questions or need further assistance, please contact us at 1-866-281-0031.
CARE APPLICATION FORM Complete each section in this application form. Provide supporting documents to prove income for all earning members in your household. Gender: Name of Consumers Energy Account Holder: M F Address: Date of Birth: (month / day / year) City, State & Zip Code: Are you disabled? Yes No Main Phone Number: Social Security Number: Home Cell Alternate Phone Number: Email Address: Home Cell Are you a veteran? Yes No Are you pregnant? Yes No Consumers Energy Account Number: Ethnicity: Highest Level of Education Completed (please circle): GED Some College High School Diploma College Graduate Advanced Degree HOUSEHOLD INFORMATION Total number of members, including applicant, in the household: Have you received utility assistance in the last 3 years? Yes No Was the utility assistance you received sufficient to get you out of shut off? Yes No If the utility assistance you received was not sufficient to get you out of shut off, did you have to find additional funds? Yes No *If necessary, use additional paper to list additonal household members (Name & Age).
HOUSEHOLD INCOME Provide supporting documents to prove income for all earning members in your household. NO INCOME If your household does not receive any income, please check the box and complete the zero-income affidavit. SELF EMPLOYED If you are self-employed, please check the box and complete the self-employment affidavit. Please Sign Below: I affirm the information provided is true, subject to verification, and if false, I will not be enrolled in Consumers Energy CARE Program. I understand that THAW Fund does not guarantee enrollment in the program, even if preliminary approval is granted. I hereby release THAW Fund, its employees, officers, directors and its partnering agencies from any liability in connection with the application. I give permission to this agency, THAW and utility vendors to request and receive information from other parties as necessary to reach a determination on my request for enrollment in the CARE program. I have read, understand and agree to these conditions and requirements. Signature (Consumers Energy account holder must sign the application) Date Mail your completed application with your supporting documentation by January 24, 2014.
EASE Survey Please answer all questions. We ask that you make your best guess in answering the questions, even if you are unsure. Circle the answer that best matches the question. 1. What type of heating system do you have? Electric heat pump Electric furnace (or electric strip heat ) Electric baseboard or wall heaters Electric thermal storage system Electric ceiling cable Gas furnace (forced air) Gas furnace (forced air) with pilot light Gas boiler (hot water/steam pipes) Gas space heater (floor/wall units) Gas heat pump Propane/LP gas furnace Propane/LP furnace with pilot light Propane/LP boiler (hot water/steam pipes) Propane/LP space heater (floor/wall units) Oil furnace Oil boiler Geothermal heat pump Add-on heat pump with gas furnace Add-on heat pump with oil furnace Other 2. When was your heating system installed? Before 1985 1985-1989 1990-1994 1995-1999 2000 or newer 3. What kind of air conditioning system do you have? Central electric A/C Electric heat pump Electric window or wall units Gas heat pump Central gas A/C Geothermal heat pump Evaporative or swamp cooler Other None 4. When was your air conditioning system installed? Before 1985 1985-1989 1990-1994 1995-1999 2000 or newer 5. How many people live in your household on a full-time basis? 1 2 3 4 5 6 7 8 9 10 6. What kind of water heater do you have? None Electric Gas Propane Fuel oil Heat pump Heat recovery Solar Other 7. How big is your home? Less than 1,000 sq. ft. 1,000-1,499 sq. ft. 1,500-1,999 sq. ft. 2,000-2,499 sq. ft. 2,500-2,999 sq. ft. 3,000-3,499 sq. ft. 3,500-3,999 sq. ft. 4,000-5,000 sq. ft. Greater than 5,000 sq. ft. 8. How old is your home? Before 1950 1950-1959 1960-1969 1970-1979 1980-1989 1990-1999 2000 or newer
CARE (Consumers Affordable Resource for Energy) Making Energy More Affordable What You ll Get A 40% discount on your bill till August 2014 Here s an example, if your bill was $100: $100 Total Energy -$40 CARE Credit =$60 You Pay An online survey tool about Energy Use called EASE (Everyday Actions Save Energy) that provides a home report with easy tips on energy savings. Invitation to have an Energy Expert visit your home for free through a program called Helping Neighbors. Depending upon your home s condition, you may receive: Water heating & lighting measures Carbon monoxide test Air sealing Furnace tune-up Insulation A friendly Agency Caseworker, who will help you understand the CARE program and is someone you can call if you have questions or need extra support. Agency: Phone number: If you cannot pay your bill by the due date, you will receive a courtesy Past-Due Reminder call 11 days following. This call is a warning that, unless payment is received within one week, you will be removed from CARE. If you are removed from CARE, you can: Make payment arrangements on the pastdue balance Enroll in the Winter Protection Plan (WPP) What You ll Give Make on-time monthly payments toward a more affordable bill. Complete initial EASE survey with your caseworker and, if you wish, log in again on your own to take a second survey for more tips. Talk about and set 3 energy savings goals with the energy expert simple steps you can take around the house to use less energy and save even more on your bill. While on CARE, understand that you cannot: Apply for State Emergency Relief (SER) energy benefit from DHS for your Consumers Energy service Be on any other Consumers Energy payment plan at the same time as CARE Make payment arrangements on any pastdue balance If you are removed from CARE due to nonpayment, you cannot: Re-enroll in CARE Enroll in the Shut-Off Protection Plan (SPP) until September 2014 Apply for State Emergency Relief (SER) energy benefit from DHS for your Consumers Energy service until Oct. 2014 I understand and agree to enroll (sign/date): /
Zero Income Affidavit Applicant Address: I hereby certify that any person in my household does not receive income from any of the following sources: a. Wages from employment (including tips, commissions, bonuses, fees, etc.); b. Income from operation of a business; c. Rental income from real or personal property; d. Social security payments, pensions, annuities, retirement funds, insurance policies, or death benefits; e. Unemployment or disability payments; f. Public assistance payments; g. Periodic allowances such as alimony, child support, or gifts received; h. Sales from self-employment; i. Any other source not named above. I certify that the information contained in this affidavit is true and accurate to the best of my knowledge. Signature Date
SELF-EMPLOYMENT AFFIDAVIT This affidavit is to be signed by any individual who is 18 years of age and over who claims on the application to be self-employed. I am self-employed in the business of: I have been self-employed in this manner since Month Day Year To the best of my knowledge, I expect to earn $ in the upcoming 12 months. This estimated earnings is supported by: previous year s tax return accountant s/bookkeeper s statement business receipts/check stubs other (identify: ) If none of the above is available, please state the reason why:. I certify that the information contained in this affidavit is true and accurate to the best of my knowledge. Signature Date