Income Eligibility Application

STOP: If you are applying to the EmPower+ Program or Comfort Home Program with ENERGY STAR® program DO NOT apply using this application. Instead, please apply directly to the programs via the Combined Residential Application.

To qualify for NYSERDA NY-Sun Affordable Solar Incentive, you must (1) be income eligible based on your total household income and (2) prove homeownership and occupancy.

Before beginning:

• Be aware that partially completed information cannot be saved.

• If you have submitted this application before and received an email with a Project Application # , select "Yes”.

• Be sure to have all documents in your possession before beginning the form.  

• For the best form completion experience, use the Google Chrome browser.  

• When you submit your application and supporting documents, you will receive a confirmation and a tracking number on your screen to print or save. Refer to this tracking number to check on the status of your request. 

To apply:

• Review the supporting documentation required for household income eligibility and for ownership/occupancy below.
• Once you have all the required supporting documentation, fill out the application
• Complete the application and upload supporting documentation in the "Supporting Documentation" section

Note: the address on all supporting documentation must match the address on the application.

To prove income eligibility:

Income eligibility can be established in one of two ways. Choose either Option 1 or Option 2.

Option 1:

Download, fill out, and save the mandatory Household Eligibility Worksheet. Then, upload it and all documents that pertain to you and each member of your household who earns income into the supporting documents section. Which supporting documents pertain to your household? If, for example, a member of your household has income for disability, include it. If no member of your household has income from a pension or veteran benefits, skip those requirements.

• Household Eligibility Worksheet - Mandatory
  • Include name, age, and income source for all household members.

The entire award letter - dated within 12 months - for one of the following:

• EmPower New York
• HEAP (Home Energy Assistance Program)
• SNAP (Food Stamps)
• TANF (Temporary Assistance for Needy Families)
• Supplemental Security Income

Option 2:

Download, fill out, and save the mandatory Household Eligibility Worksheet. Then, upload it and all documents that pertain to you and each member of your household who earns income into the supporting documents section. Which supporting documents pertain to your household? If, for example, a member of your household has income for disability, include it. If no member of your household has income from a pension or veteran benefits, skip those requirements.

• Household Eligibility Worksheet - Mandatory
  • Include name, age, and income source for all household members.
• Social Security and/or Social Security Disability (copy of award letter(s))
• Documentation of all forms of income for each member of your household that earns income including, if applicable:
  • Disability
  • Worker’s compensation
  • Unemployment
  • Pension
  • Maintenance
  • Annuities
  • Veteran’s benefits
• Tax Returns (This option is only available if all household members who were required to file a tax return did so. If documenting income with tax returns, all sources of income must be documented with tax returns. Returns must be the most recent Federal Income Tax Return (Form 1040, 1040A, or 1040EZ)
• All other income (i.e. paystubs for all household gross income for the last 60 days.)
  • Weekly: multiply weekly income representing 4 most recent weeks by 4.3
  • Bi-weekly: multiply 2 most recent consecutive weeks by 2.15
  • Twice a month: multiply by 2
• Self-Employment IRS Report of Quarterly earnings for the past three months.

To prove homeownership:

Upload one (1) of the following documents:

• Recent water bill dated within the last 180 days OR
• Recent property tax bill dated within the last 180 days

AND

• Utility Bill - electric, gas, telephone, cable within the last 90 days

* Required Field

To learn more about our other energy efficiency programs visit EmPower+ - NYSERDA

Please upload the Household Eligibility Worksheet and your entire award letter dated within the past 12 months for one of the following:

• Household Eligibility Worksheet

• EmPower+

• HEAP (Home Energy Assistance Program)

• SNAP (Food Stamps)

• TANF (Temporary Assistance for Needy Families)

• Supplemental Security Income

Please provide the following income documentation as it applies

• Household Eligibility Worksheet

• Social Security and Social Security Disability: award letter

• Documentation of all forms of income including:

  • Disability (Award Letter)

  • Worker’s compensation (Award Letter)

  • Unemployment (Award Letter)

  • Pension (Award Letter or Statement)

  • Maintenance

  • Annuities

  • Veteran’s benefits

Tax Returns (This option is only available if all household members who were required to file a tax return did so. If documenting income with tax returns, all sources of income must be documented with tax returns. Returns must be the most recent Federal Income Tax Return (Form 1040, 1040A, or 1040EZ)

All other income (i.e. paystubs for all household gross income for the last 60 days.)

• Weekly: multiply weekly income representing 4 most recent weeks by 4.3

• Bi-weekly: multiply 2 most recent consecutive weeks by 2.15

• Twice a month: multiply by 2

• Self-Employment IRS Report of Quarterly earnings for the past three months

Please ensure your document file name does not include any special characters, such as ~! @#$%^&*_-+=`|\(){}[]:;"'<>,.?/. 

If you are working with a Contractor and would like them to be kept apprised of the status of this application please complete this section below.

The application must be signed by the customer, whose name is listed above.

By signing below, I certify that all information provided on this application, including statements and documents submitted in connection with this application, are correct, complete, and accurately document the income of all members of my household, to the best of my knowledge. I acknowledge that NYSERDA has retained a Contractor to process my income qualification application. If necessary, I further agree to provide additional information to complete my income screening application process.

I further acknowledge and agree that NYSERDA and its Contractor may share with and disclose to, orally and/or in writing the project partners identified by me above, or as subsequently identified by me to the Contractor, the following information regarding this application; whether the application has been approved by the Contractor, and any additional items requested by the Contractor in order to complete my income qualification application; whether the application has been approved by the Contractor; and whether my application has been denied, so that the project partner(s) can determine whether I intend to proceed.

I understand that my signature on this form gives permission for NYSERDA, or its designee, to verify records necessary to assure my program eligibility. I understand that if I give false information or withhold information in order to make myself eligible for benefits that I am not entitled to, I can be prosecuted to the fullest extent of the law.

I understand this application does not guarantee assistance will be granted but will be used in determining eligibility for the program. Whether or not an eligible applicant will be provided assistance will depend in part upon the number of applicants received, the remaining funding available, and the priorities to be met by the program.

Whether or not the undersigned have elected to sign this document electronically, the Contractor, and or any subsequent holders of this document, shall have the right to convert and store the manual signature electronically, and the undersigned consents to the use of electronically stored version in the same manner as an original signed copy.

I understand and intent that a legal signature is formed by entering my name on this and other documents provided to me, and by entering my name on this and other documents provided in relation to this transaction I intent for my electronic signature to have the same force and effect as my manual signature. If any of the parties do not wish to sign this document electronically all must opt out together and request a paper copy to sign manually.