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 [pdf 113kB]

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, 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

Refrigerator Replacement Form [pdf  269kB]

Chapter  5

Certification of Insulation [pdf 271kB]

   
   

Chapter  6

Affirmative Action Affidavit [Word Doc 28kB]

Chapter  6

Bid Package Review Checklist [Word Doc 68kB]

Chapter  6

Contractor Registration Application [Word Doc 36kB]

Chapter  6

Justification for Selection of Contractor [Word Doc 33kB]

Chapter  6

Non-Collusion Affidavit of Prime Bidder [Word Doc 31kB]

Chapter  6

Sample Contract for Weatherization Services [pdf 317kB]

   
   

Chapter  7

Appliance/ Heating Systems Evaluation [pdf  89kB]

Chapter  7

Heating System Improvement Program Checklist [pdf 193kB]

Chapter  7

Heating System and Hot Water Heater Improvement Survey Report [pdf 86kB]

Chapter  7

Heating System Improvement Dealer/Service Contractor Assurances [pdf 75kB]

Chapter  7

Post Installation Report Heating Systems [pdf 68kB]
   

Chapter  8

Approval Form to Exceed Maximum Allowable Cost Per Unit [pdf 147kB]

Chapter  8

Certification Regarding Debarment [pdf 10kB]

Chapter  8

Certification Regarding Drug-Free Workplace Requirements [pdf 57kB]

Chapter  8

Certification Regarding Lobbying [pdf 69kB]

Chapter  8

Special Instructions for Equipment purchases over $5,000.00 [pdf 101kB]

Chapter  8

File Content and Compliance Check List [pdf 123kB]

Chapter  8

Reweatherization Approval Form [pdf 59kb]