How to Fill Out and Submit the New York HEAP Application (LDSS-3421)

To apply for New York’s Home Energy Assistance Program, you fill out Form LDSS-3421 with your household, income, and heating information, sign it, attach four weeks of income proof and a recent heating bill, and send it to your local Department of Social Services. Knowing how to fill out the New York HEAP application (LDSS-3421) mostly comes down to having the right documents in front of you before you start, because the form itself is short and the questions are straightforward once your paperwork is organized.

The 2025-2026 regular HEAP benefit opened December 1, 2025, and applications are accepted until funding runs out, so applying early matters. Payments go directly to your utility company or fuel vendor rather than to you.

Gather Your Documents Before You Start

Sitting down with a blank LDSS-3421 before your paperwork is together is where most applications stall. Pull these items first:

Full legal names, dates of birth, and Social Security numbers for every person living in your home, including children.¹
Pay stubs covering the last four weeks for every earner, plus Social Security award letters, pension statements, or other proof of gross income before deductions.¹
A recent utility bill or fuel delivery receipt showing your account number, the name on the account, and your vendor’s name. If you heat with oil, kerosene, or propane, have your delivery company’s contact information ready.
Case numbers for anyone in the household receiving SNAP, Temporary Assistance, or Supplemental Security Income.
A lease or rent receipt confirming the arrangement, if heat is included in your rent.

One shortcut worth knowing: if you already receive SNAP, Temporary Assistance, or Code A Supplemental Security Income, you may be automatically processed for a HEAP benefit without filing a separate application. Watch your mail during HEAP season before you file anything.

Eligibility depends on gross monthly household income falling at or below the limit OTDA publishes each year,² on being responsible for heating costs either directly or through your rent, and on being a New York resident who is a U.S. citizen or qualified non-citizen. The 2025-2026 income ceiling starts at $3,473 per month for a one-person household and rises with household size.³

Filling Out the Form Section by Section

The LDSS-3421 runs a few pages and is broken into labeled blocks. Work through them in order.

Household Information

Start at the top with your name, address, phone number, and date of birth. Below that, a table asks you to list every person living in your home, related or not. For each person, enter their full name, Social Security number, date of birth, and relationship to you. If you live alone, write “NONE” under your name in the additional members section.⁴ The household size you enter here is what your income will be measured against, so count carefully.

Income Reporting

Report gross monthly income for every household member. The form breaks income into categories: wages, Social Security, pensions, unemployment insurance, and self-employment. Enter each figure in its box. If a household member has no income, put a zero on their line rather than skipping the row. Attach the four weeks of wage stubs and any award letters or benefit statements.¹ Missing income documentation is one of the most common reasons applications get held up.

Heating and Housing Details

Identify your primary heating fuel: natural gas, electricity, oil, kerosene, propane, or wood. Benefit amounts vary by fuel type, so this answer matters. Then indicate whether you pay heating costs directly or they are included in your rent. If you pay directly, give your fuel vendor’s name, address, and your account number. If heat is included in your rent, note your landlord’s name and contact information.

SNAP and Other Benefits

One block asks whether anyone at your address receives SNAP and, if so, their name and case number. Providing the case number lets the local office cross-reference your eligibility and speed the review.

Signature and Date

The head of household has to sign and date the form. An unsigned application will be sent back. If someone else fills it out for you, you still need to sign it yourself.

Where to Get the Form and How to Submit It

You can download the LDSS-3421 from the OTDA website at otda.ny.gov/programs/applications/3421.pdf. Paper copies are available at your local Department of Social Services office, and the form comes in large print, audio, and accessible data formats from the same OTDA page.

Once your form is signed and your supporting documents are attached, you have three ways to file:

In person at your local HEAP office during regular business hours. OTDA lists local contacts at otda.ny.gov/programs/heap/contacts/.
By mail to your local District Social Services office. Use the address for your county, not a central state address.
By phone in New York City, at 718-557-1399.⁵

Photocopy everything you submit. If you mail the application, use a method that gives you a delivery receipt. There is no fee to apply.

One boundary to keep in mind: if your heat has already been shut off, you are out of fuel, or you have a disconnection notice, the Emergency HEAP benefit is handled separately by phone or in person at your local HEAP office, not by mailing in an LDSS-3421.⁵

What Happens After You Send It In

The local office reviews your income documents, verifies your household composition, and confirms your heating arrangement with your vendor. You will get a written decision by mail. If you are approved, the notice states the exact dollar amount of your grant and names the vendor receiving payment; the money goes to your utility or fuel supplier rather than to you. If you are denied, the notice explains why and tells you how to request a fair hearing, which you have 60 days to do.

1
New York State Office of Temporary and Disability Assistance. LDSS-3421 – Home Energy Assistance Program Application
2
Legal Information Institute. New York Code 18 NYCRR 393.4 – Eligibility
3
The State of New York. Apply for Heating Assistance (HEAP)
4
New York State Senate. LDSS-3421 New York HEAP Application
5
NYC Human Resources Administration. Energy Assistance