The following Forms are DCA issued forms and are to be used by all participating WAP agencies. These documents are not to be altered and are required in all client files when applicable.

Chapter  1

Affidavit of No Income for Applicant [pdf 46kB]

Chapter  1

Affidavit of No Income for Member of Household [pdf 46kB]

Chapter  1

Certification of No Income Tax Filing For Applicant [pdf 46kB]

Chapter  1

Certification of No Income Tax Filing for Member of Household [pdf  46kB]

Chapter  1

Certification of No Social Security Numbers [pdf 46kB]

Chapter  1

Emergency Services Acknowledgement Form [pdf 85kB]

   

Chapter  2

Affidavit for Vacant Units Multi Family Only (5 units or more) [pdf 64kB]

Chapter  2

Application for Shelters, Group Homes, and Transitional Facilities [pdf 89kB]

Chapter  2

Landlord Contribution Agreement Single Family Dwellings (1-4 units) [pdf  69kB]

Chapter  2

Landlord/Tenant Weatherization Agreement Form Multi-Family Only (5 units or more) [pdf  69kB]

Chapter  2

Multi-Family Building Improvement Program Escrow Agreement (Agency Crew) [pdf  72kB]

Chapter  2

Multi-Family Building Improvement Program Escrow Agreement (Contractor) [pdf  72kB]

Chapter  2

Net Rental Income Calculation Sheet [Excel file 35kB]

Chapter  2

Owner's Permission to Weatherize [pdf  113kB]
   
 

Chapter  3

ASHRAE 62.2 - 2013 Residential Ventilation Standard (Provided by Heyoka) [xls 288kB]

Chapter  3

Residential Energy Dynamics (Red) Calculation Sheet 

Chapter  3

Checklist for Performing RRP on Dwelling Built Before 1978 [pdf 71kB]

Chapter  3

Data Collection/Health & Safety Assessment/Educational Material Notification [pdf 514kB]

Chapter  3

Determination of Lead Safe Weatherization (LSW) on Dwelling Built before 1978 [pdf 71kB]

Chapter  3

Health and Safety Client Intake Survey [pdf  71kB]

Chapter  3

Health and Safety Deferral Notice [pdf 67kB]

Chapter  3

Health and Safety Deferral Request Form [pdf 59kB]

Chapter  3

Lead, Mold, Radon and Asbestos Assessment Determination [pdf 73kB]

Chapter  3

Radon Testing Waiver [pdf 64kB]
 
   

Chapter  4

Data Collection/Health & Safety Assessment/Educational Material Notification [pdf  514kB]
   
 

Chapter  5

Affirmative Action Affidavit [pdf 317kB]

Chapter  5

Bid Package Review Checklist [pdf 276kB]

Chapter  5

Contractor Registration Application [pdf 290B]

Chapter  5

Justification for Selection of Contractor [pdf 205kB]

Chapter  5

Non-Collusion Affidavit of Prime Bidder [pdf 203kB]

Chapter  5

Sample Contract for Weatherization Services [pdf 282kB]

   
   

Chapter  6

Appliance/Heating Systems Evaluation [pdf  282kB]

Chapter  6

Heating System Improvement Program Checklist [pdf 1262kB]

Chapter  6

Heating System and Hot Water Heater Improvement Survey Report [pdf 350kB]

Chapter  6

Heating System Improvement Dealer/Service Contractor Assurances [pdf 262kB]

Chapter  6

Heating Systems & Hot Water Heater Post Installation Reports [pdf 188kB]
   

Chapter  7

Approval Form to Exceed Maximum Allowable Cost Per Unit [pdf 259kB]

Chapter  7

Certification Regarding Debarment [pdf 10kB]

Chapter  7

Certification Regarding Drug-Free Workplace Requirements [pdf 119kB]

Chapter  7

Certification Regarding Lobbying [pdf 194kB]

Chapter  7

File Content and Compliance Check List [pdf 109kB]

Chapter  7

Reweatherization Approval Form [pdf 254kb]

Chapter  7

Special Instructions for Equipment purchases over $5,000.00 [pdf  211kB]

Chapter  7

Vehicle Purchases/Lease Approval Form [pdf 285kB]
 
 
Refrigerator Replacement Form [pdf  276kB]
 

Certification of Insulation [pdf  177kB]