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Structure

The Leap application IML-4 form serves as a crucial tool for individuals and organizations navigating various processes within the legal and administrative landscape. Designed to streamline the application process, this form encompasses several key components, including personal information, application details, and specific requirements tailored to the applicant's situation. By providing clear sections for relevant data, the IML-4 form helps ensure that all necessary information is collected efficiently, reducing the likelihood of delays or complications. Additionally, the form is structured to accommodate different types of applicants, whether they are individuals seeking assistance or businesses pursuing compliance. Understanding how to fill out the IML-4 form correctly is essential for a smooth application experience, making it important for users to familiarize themselves with its layout and instructions. With the right guidance, applicants can navigate this form with confidence, paving the way for successful outcomes in their respective endeavors.

Common mistakes

  1. Incomplete Information: One common mistake is failing to provide all required information. Each section of the form must be filled out completely. Missing information can lead to delays or even denial of the application.

  2. Incorrect Personal Details: Applicants often make errors when entering their personal details, such as name, address, or date of birth. Double-checking this information is crucial to avoid complications.

  3. Failure to Sign: A simple yet significant mistake is forgetting to sign the application. Without a signature, the application is considered incomplete and will not be processed.

  4. Not Reviewing the Application: Some individuals submit their applications without reviewing them. Taking the time to proofread can help catch mistakes before submission.

  5. Ignoring Instructions: Each application form comes with specific instructions. Ignoring these can lead to errors in filling out the form, which may affect the outcome.

  6. Missing Supporting Documents: Many applicants forget to include necessary supporting documents. Ensure that all required documents are attached, as this can significantly impact the processing of the application.

Preview - Leap application IML-4 Form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE ALL

 

 

APPLICATION FORM

 

4 PAGES AND

 

 

Colorado Department of Human Services—LEAP

 

SIGN PAGE 4

(Program Year is November 1st–April 30th)

 

1001 E 62nd Avenue

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Denver CO 80216-1140

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Case

Payment Method

 

 

Technician

 

 

 

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Date Received

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O1. APPLICANT

If you need assistance in completing this application, call HEAT HELP at 1-866-432-8435.

Last Name

 

First Name

 

 

Middle Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address of Residence

 

 

 

City

 

 

State

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (If Different Than Residence)

 

 

City

 

 

State

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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U.S. citizen?

 

 

 

 

 

 

 

 

Male

 

 

 

 

 

 

 

 

 

 

 

 

Female

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email Address

 

 

 

 

In which county do you live?

 

 

 

Are you a registered alien?

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

O 2. OTHER HOUSEHOLD MEMBERS

Complete the following for any other members of your household. “Your household” means the people who live with you for whom you have

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Name

(List all household members)

Social Security

Number

Date of

Birth

Relationship

to You

Age

Sex

Place of Birth

Do you

Are you

have

a U.S.

income?

citizen?

Yes No

Yes No

 

 

*Are you a registered alien?

Yes No

*If you or members of your household are a registered alien, PLEASE ATTACH A PHOTO COPY (FRONT & BACK) OF THE ALIEN REGISTRATION CARD(S) TO THE APPLICATION.

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Name

Relationship to You

Age

IML–4 (R 7/16) IDS/RC

Page 1 of 4

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615-82-10-4008

 

 

O 4. HOUSEHOLD INCOME

Does anyone in your household have work income? Yes No

Who Receives It?

How Often Paid?

Gross Monthly

Amount

Employer Name

Initial this box that you have attached copies of pay stubs for at least the 4 weeks prior to the date of application

Does anyone in your household have self-employment work income? (Includes baby sitting, etc.) Yes No

Who Receives It?

How Often Paid?

Gross Monthly

Amount

Employer Name

Initial this box that you

have attached copies of VHOIHPSOR\PHQWSUR W and loss statement for the

month previous to your date

of application

Does anyone in your household have non-work income (which includes any public assistance programs) as listed below? Yes No

Social Security income (SSA); Supplemental Security Income (SSI); Supplemental Security Disability Income (SSDI); Colorado Works (TANF);

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Who Receives It?

How Often Paid?

Gross Monthly

Amount

Type of Non-Work Income

as Listed Above

Initial this box that you have attached copies of award letters for the month previous to your date

of application

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How did you pay for these following costs if your household income does not cover your basic living expenses?

Rent:

Food:

Utilities:

Other:

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Check ( ) the item that best describes the dwelling where you currently live and are applying for assistance.

House/Modular Home

Rooming/Boarding House

Fraternity or Sorority House

Cabin

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Hotel/Motel

Rehabilitation Center

Camper

Townhouse

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Apartment/Condominium

Group Home

Nursing Home/Residential Care Facility

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Mobile Home

Dormitory

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Do you have a mortgage payment? Yes.

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What is the name and phone number of your apartment complex?

O 6. SUBSIDIZED HOUSING

Do you live in Section 8, public housing, or do you receive a subsidy to pay your rent? Yes No

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O 7. HEAT/RENT INFORMATION

ARE YOU HAVING AN EMERGENCY WITH YOUR PRIMARY HEATING FUEL RIGHT NOW? Yes

If yes, check type of emergency below and attach a copy of the notice from your energy provider:

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Check ( ) the main fuel used to heat (not light) your residence. CHECK ONLY ONE.

Natural Gas Propane Electricity Wood Coal Fuel Oil Kerosene Other: ($3FDQQRWDVVLVWRUSURYLGHDEHQH WIRUDQ\W\SHRISRUWDEOHKHDWLQJV\VWHPV

Check ( ) the way in which the heat (not light) is paid for at your residence.

I pay heating costs directly to a utility company or fuel dealer. (If so, attach copy of most recent heating bill).

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If your electricity is supplied by a different company, please provide:

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Heat is included in my rent. (If so, attach a copy of the most recent rent receipt that already shows heat is included.)

Someone other than a member of my household pays my heating costs.

Provide name and address of that person and their relationship to you.

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State law requires applicants for LEAP to provide additional documents with each LEAP application. A READABLE COPY of one of the following VALIDLGHQWLÀF WLRQVPXVW HSURYLGHG

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3.A United States Merchant Mariner card; or,

4.A Native American Tribal document.

5.Any other document authorized by rules adopted by the Colorado Department of Revenue (DOR).

IN ADDITION: 7KH SSOLF QWIRU ($3PXVW OVRFRUUHFWO\FRPSOHWHVLJQ QGG WHWKH$IÀG YLWORF WHG HORZ

For more information regarding Lawful Presence law and requirement please go to the DOR web site at: http://www.colorado.gov/revenue.

AFFIDAVIT

for the Colorado Department of Human Services and the Department of Health Care Policy and Financing as Proof of Lawful Presence in the United States

,

Check{ only one

box

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I am a United States citizen, or

I am a legal Permanent Resident of the United States, or

I am lawfully present in the United States pursuant to federal law.

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_________________________________________________________________________________

_______________________________________________________

Signature

Date

Page 3 of 4

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O 9. ADDITIONAL INFORMATION

Information reported in this section will not be used to determine your eligibility for LEAP or your payment level. This information will only be used for statistical information.

Check ( ) here if any member of your household is: Handicapped or disabled

Race of applicant: Hispanic White Black or African American American Indian or Alaska Native Asian

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I learned about LEAP from the following source (check only one):

Friend

1-866-HEAT-HELP (432-8435)

Senior Center

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LEAP Poster

Newspaper

Billboard

PEAK Website

Heating Company

Radio

Bus Benches

Other

Received Application in Mail

LEAP Website

Television

 

O 10. CONSENT TO DISCLOSE CUSTOMER DATA

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Your utility account payment history and other account details, such as utility charges, payment history, past due amounts, pending deposits, current shut-off due dates or disconnection, current life support status, payment arrangements, and history of energy assistance payments.

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Please note that:

You are not required to authorize your utility service provider to disclose your customer data.

Your decision not to authorize the disclosure will not affect your utility services.

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O 11. SIGNATURE AND CONSENT

By signing below I understand, I acknowledge and agree that:

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3.The Colorado Department of Human Services (CDHS) may use my Social Security Number to get wage data, amount of unearned income, child

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6.If LEAP repairs or replaces my heating system and I refuse to allow access to my dwelling for the purposes of completing the service

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8.I declare that the information given by me in this application is true and correct. I understand the penalty for providing false information. $SHUVRQFRQYLFWHGRIIU XGXOHQW FWLYLW\F QQRWJHW ($3 VVLVW QFHIRUWKUHH\H UVIRUWKHÀUVWFRQYLFWLRQ QGSHUP QHQWO\IROORZLQJWKH second conviction.

W S I G N F U L L N A M E B E L O W W

 

Signature: __________________________________________________________

Date:________________

 

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If someone helped the applicant complete this application, such person must sign below.

 

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If you would like to know the status of your application please call HEAT HELP at 1-866-432-8435.

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Documents used along the form

The Leap application IML-4 form is a crucial document in various administrative processes, particularly in immigration and legal contexts. However, it is often accompanied by several other forms and documents that help provide a comprehensive picture of an applicant's situation. Below is a list of commonly used forms and documents that may accompany the IML-4 form.

  • Form I-485: This is the Application to Register Permanent Residence or Adjust Status. It allows individuals to apply for a green card while in the United States.
  • Form I-130: This is the Petition for Alien Relative. It establishes a relationship between a U.S. citizen or lawful permanent resident and a foreign relative who wishes to immigrate.
  • Form I-864: The Affidavit of Support is required to demonstrate that the immigrant has adequate financial support and will not become a public charge.
  • Form I-601: This is the Application for Waiver of Grounds of Inadmissibility. It is used to request a waiver for certain immigration violations.
  • Form I-797: This is a Notice of Action, which serves as a receipt or approval notice for various immigration applications and petitions.
  • Form G-325A: The Biographic Information form collects personal information about the applicant, including details about their family and employment history.
  • Power of Attorney Form: This important document allows an individual to designate someone else to make legal and financial decisions on their behalf, which can be crucial in times of need, as detailed on georgiapdf.com/.
  • Form I-693: This is the Report of Medical Examination and Vaccination Record, which documents the applicant's health status and vaccination history.
  • Form N-400: This is the Application for Naturalization, used by individuals seeking to become U.S. citizens.
  • Form I-94: This is the Arrival/Departure Record, which provides evidence of an individual's legal entry into the United States and the terms of their stay.
  • Form I-821D: The Consideration of Deferred Action for Childhood Arrivals (DACA) form is used by individuals seeking deferred action status based on specific criteria.

Each of these forms plays a significant role in the immigration process, ensuring that all necessary information is collected and evaluated. Understanding the purpose of each document can help applicants navigate their legal journey more effectively.

Similar forms

The Leap application IML-4 form shares similarities with the Form I-130, Petition for Alien Relative. Both documents serve to establish a relationship between a U.S. citizen or lawful permanent resident and a foreign national. The I-130 form is primarily used to initiate the immigration process for family members, while the IML-4 form is focused on individuals seeking a specific immigration benefit. Each form requires supporting documentation to prove the claimed relationship or eligibility for the requested benefit.

Another document comparable to the IML-4 form is the Form I-485, Application to Register Permanent Residence or Adjust Status. This form is used by individuals who are already in the United States and wish to apply for a green card. Similar to the IML-4, the I-485 requires a thorough background check and documentation to establish eligibility for permanent residency. Both forms are integral to the immigration process and require careful attention to detail in their completion.

The Form I-864, Affidavit of Support, is also similar to the IML-4 form. This document is necessary for most family-based immigration applications and ensures that the immigrant will not become a public charge. Like the IML-4, the I-864 requires financial information and documentation to demonstrate that the sponsor can support the immigrant financially. Both forms play a critical role in the overall immigration process, focusing on the applicant's ability to thrive in the U.S.

The Form N-400, Application for Naturalization, bears some resemblance to the IML-4 form as well. This document is used by lawful permanent residents seeking U.S. citizenship. Both forms require applicants to provide personal information, undergo background checks, and submit to an interview process. The N-400 focuses on the applicant's qualifications for citizenship, while the IML-4 centers on specific immigration benefits, highlighting the importance of documentation in both cases.

Similar to the IML-4 form is the Form I-765, Application for Employment Authorization. This form allows certain individuals to request permission to work in the United States. Both the I-765 and IML-4 require applicants to provide personal information and may necessitate supporting documentation to establish eligibility. The I-765 is specifically focused on employment rights, while the IML-4 addresses broader immigration benefits.

The Form I-131, Application for Travel Document, also shares characteristics with the IML-4 form. This document is used to apply for re-entry permits, refugee travel documents, or advance parole. Both forms require applicants to provide detailed personal information and may involve similar supporting documents to establish eligibility. The I-131 focuses on travel permissions, while the IML-4 addresses immigration benefits, but both are essential in the immigration process.

When engaging in a vehicle transaction, it's imperative to utilize the appropriate documentation to safeguard both parties involved. For instance, the Ohio Motor Vehicle Bill of Sale form is essential, as it documents the sale and transfer of ownership. To learn more about this important form, visit autobillofsaleform.com/ohio-motor-vehicle-bill-of-sale-form.

The Form I-600, Petition to Classify Orphan as an Immediate Relative, is another document akin to the IML-4 form. This form is used by U.S. citizens seeking to adopt a foreign orphan. Like the IML-4, the I-600 requires proof of eligibility and supporting documentation to establish the relationship between the petitioner and the child. Both forms are crucial in facilitating family reunification through immigration channels.

The Form I-90, Application to Replace Permanent Resident Card, is also similar to the IML-4 form. This document is used by lawful permanent residents who need to renew or replace their green card. Both forms require personal information and may necessitate documentation to support the application. The I-90 focuses on maintaining lawful permanent resident status, while the IML-4 addresses specific immigration benefits.

Lastly, the Form N-600, Application for Certificate of Citizenship, has similarities with the IML-4 form. This document is used by individuals who claim U.S. citizenship through their parents. Both forms require detailed personal information and documentation to verify the claims made by the applicant. The N-600 focuses on establishing citizenship status, while the IML-4 is concerned with immigration benefits, underscoring the importance of accurate information in both cases.

Dos and Don'ts

When filling out the Leap application IML-4 form, it is important to follow specific guidelines to ensure accuracy and completeness. Here are five things you should and shouldn't do:

  • Do: Read the instructions carefully before starting the application.
  • Do: Provide accurate and up-to-date information in all sections.
  • Do: Double-check your entries for any errors or omissions.
  • Don't: Rush through the application; take your time to ensure everything is correct.
  • Don't: Leave any required fields blank; all sections must be completed.

Key takeaways

Filling out the Leap application IML-4 form can be straightforward if you keep a few key points in mind. Here are some important takeaways to guide you through the process:

  1. Understand the Purpose: The IML-4 form is used for specific applications within the Leap system. Knowing its purpose helps you provide accurate information.
  2. Gather Required Information: Before starting, collect all necessary documents and details. This includes personal information and any relevant identification numbers.
  3. Follow Instructions Carefully: Each section of the form has specific instructions. Read them thoroughly to avoid mistakes.
  4. Use Clear and Concise Language: When filling out the form, be straightforward. Avoid jargon and complex terms to ensure clarity.
  5. Check for Accuracy: Double-check all entries for accuracy. Errors can lead to delays or complications in processing.
  6. Keep a Copy: Always make a copy of the completed form for your records. This can be helpful for future reference.
  7. Submit on Time: Pay attention to deadlines. Late submissions may not be accepted, affecting your application.
  8. Follow Up: After submission, monitor the status of your application. Don’t hesitate to reach out if you have questions.
  9. Seek Assistance if Needed: If you’re unsure about any part of the form, consider seeking help. Resources are available to assist you.
  10. Stay Informed: Keep up with any updates related to the Leap application process. Changes can occur, and staying informed is crucial.

By keeping these points in mind, you can navigate the Leap application IML-4 form more effectively.

How to Use Leap application IML-4

Filling out the Leap application IML-4 form is a straightforward process that requires careful attention to detail. Once completed, the form will be submitted for processing, which may lead to the next steps in your application journey.

  1. Begin by downloading the Leap application IML-4 form from the official website.
  2. Open the form using a PDF reader or a word processor that supports the format.
  3. Fill in your personal information in the designated fields, including your name, address, and contact details.
  4. Provide any required identification numbers, such as Social Security Number or Tax Identification Number, if applicable.
  5. Complete the sections that ask for your employment history and educational background.
  6. Answer any specific questions related to your application, ensuring accuracy and honesty.
  7. Review all entries for completeness and correctness.
  8. Sign and date the form where indicated.
  9. Save the completed form to your device.
  10. Submit the form according to the instructions provided, whether electronically or by mail.