May Be Services Department

ENERGY ASSISTANCE

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Hartford, CT 06114-0000

Phone: 860-***-**** Fax #: 860-***-****

Hours: 08:00 AM to 04:00 PM

Date : 12/19/2023

PEREZ, CARLOS A

** ******** ** ***: . Flr: 3

HARTFORD CT 06106-3007

Energy Assistance Case # 20247532

Dear Sir or Madam:

Your application for Energy Assistance cannot be processed for the following reason - WE HAVE NOT RECEIVED THE INFORMATION NEEDED TO DETERMINE YOUR ELIGIBILITY We may be able to complete your application if you provide the information we need as checked and specified below. Please drop off, email, or fax the required proofs as soon as possible. Call or email us if you need help getting proof. Income Information is missing for at least 1 member Utility Information e.g. Utility(gas/electric)bill with account number PLEASE PROVIDE HOUSEHOLD INCOME DATED BETWEEN 11/3/2023 AND 11/24/2023, GAS BILL, ELECTRIC BILL. RETURN VIA DROP OFF,FAX OR EMAIL. (G) CGB Social Security Number is missing for at least (1) member of Household Other

* If you provide us with this documentation within 10 days of the postmark date of this letter, not counting state- designated holidays, we will reprocess your application. The Energy Assistance Programs are open until May 31st. If you choose to reapply, you must do so by that date. If you reapply, you will be asked to provide updated documentation. These are not entitlement programs. The State has the right to close the programs early if funding is not available. You have the right to a Desk Review concerning the decision made on this application. Requests must be made in writing and sent to our Energy Office within sixty (60) days of the discovery of the occurrence, or by September 30th, whichever comes first.

Persons who misrepresent their household circumstances or income are required to repay any assistance that was provided. In addition, the household will be suspended from participation in the Energy Assistance Programs for the remainder of the current program year, and for the following two (2) program years. If you have questions about this letter, please contact our Energy Office. Sincerely,

CRT Energy Assistance Program Energy Services Department

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