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Brevard County Community Action Agency

Dr. Joe Lee Smith Community Center 415 Stone Street Cocoa, FL 32922

(321) 633-1951

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Thank you for your interest in the Brevard County Low Income Home Energy Assistance Program (LIHEAP).

You must fall into one of these categories to be given priority during the first week of the month.
  • ELDERLY (Must be at least sixty years old)
  • DISABLED (Must be receiving disability benefits from either Social Security Administration or employer/insurance disability benefits)
  • HOUSEHOLDS WITH CHILDREN UNDER THE AGE OF FIVE (Must provide Birth Certificates for children five years old or younger)
  • APPROVED FAMILY SELF-SUFFICIENCY PROGRAM (Actively participating in the Family Self-Sufficiency Program)
You will need to complete this online application and submit it with the following information listed below.
  • Completed application. (Note: on the first page of the application, the column next to the name column requests an applicant number, this is your social security number. This must be completed in order to process your application.)
  • Valid Florida Driver’s License or Florida Identification Card for all adult household members with a Brevard County address.
  • Original Social Security Card(s) for all household members.
  • Birth Certificates for all children that are listed on the application.
  • Verification of all household income for the past 60 days. If you are receiving Unemployment Compensation Benefits you will need to call 1 (800) 204-2418 for a payment history for the past 60 days. If you are receiving Social Security, Supplemental Security Income, Social Security Disability, Pension, Alimony, Annuity, Aid to Families with Dependent Children (AFDC)/Temporary Assistance for Needy Families (TANF), Retirement, Workman’s Comp, VA, Child Support, Utility Allowance Reimbursement or etc. You will need to provide a current printout for the past 60 days. A Self Declaration Form must be completed by all adult household members that have zero income or self-employment for the past 60 days.
  • A copy of an electric/gas energy bill, current yearly lease, HUD Form 50059 from Subsidized Housing, Rent Voucher Worksheet Form from Section 8, and Rent Adjustment Notice Form from Public Housing Authority.
Please note that incomplete applications will not be accepted. You must have all documents. If you have any questions, or we can be of any assistance, please feel free to contact us at (321) 633-1951.
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Upload Attachment(s)

Please upload the following attachments:

  • Additional Family Members (if applicable).
  • Copy(s) of a valid Florida Driver's License or Florida Identification Card for all adult household members (mandatory).
  • Copy(s) of original Social Security Card(s) for all household members (mandatory).
  • Copy(s) of birth certificates for all children that are listed on the application (mandatory).
  • Verification of all household income for the past 60 days for example, paystubs, Social Security Award Letter, Unemployment Compensation Benefits Payment History (call 1-800-204-2418), etc. (mandatory).
  • Self-Declaration Form for all adult household members that have zero income or self-employment for the past 60 days (located at www.brevardfl.gov/HumanServices/Home).
  • Copy of an Electric or gas energy bill (mandatory).
  • Copy of lease (if applicable, HUD Form 50059 from Subsidized Housing, Rent Voucher Worksheet Form from Section 8, and Rent Adjustment Notice Form from a Public Housing Authority).

There is a 250MB limit on each attachment.

Additional Household Members (please include their Name (first, middle, last), Social Security Number, Date of Birth, Sex, Race, Relationship to Applicant, Source of Income (if applicable), and Monthly Income (if applicable). Click Here to Upload
Copy(s) of a valid Florida Driver's License or Florida Identification Card for Head of Household Click Here to Upload
Copy(s) of birth certificates for all children that are listed on the application. Click Here to Upload
Verification of all household income for the past 60 days for example, paystubs, Social Security Award Letter, Unemployment Compensation Benefits Payment History (call 1-800-204-2418), etc. (mandatory). Click Here to Upload
Self-Declaration Form for all adult household members that have zero income or self-employment for the past 60 days (located at www.brevardfl.gov/HumanServices/Home). Click Here to Upload
Copy of an Electric or gas energy bill. Click Here to Upload
Copy of lease (if applicable, HUD Form 50059 from Subsidized Housing, Rent Voucher Worksheet Form from Section 8, and Rent Adjustment Notice Form from a Public Housing Authority). Click Here to Upload
Identification for Additional Adult Household Member(s) Click Here to Upload
Copies of Social Security Card(s) Click Here to Upload
Any additional documents Click Here to Upload
Any additional documents Click Here to Upload
Any additional documents Click Here to Upload
Any additional documents Click Here to Upload
Any additional documents Click Here to Upload