Empower New York Program Application Checklist
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8APPLICATION CHECKLIST
EmPower New York Program
This checklist will help ensure that your application will be processed in a timely manner. Please place a ☑ in
the appropriate box once you have ensured that all Application Sections are complete and the required
documentation is provided. Applications are processed on a first come, first serve basis.
General Applicant Information (Sections A, B & C) – Verify that all required fields are completed
(unless marked as “optional”).
Energy Information (Section D):
Sign Customer Fuel/Energy Bill Release Authorization
Include a copy of complete Electric Bill
Include a copy of complete Gas Utility Bill or bill from Fuel Supplier if heating by propane, oil, kerosene,
wood or coal
OWNERS ONLY:
Include ONE of the following as Proof of Ownership:
Current Property/School Tax Bill
Deed
Bill of Sale for mobile/manufactured homes
Mortgage Statement
RENTERS ONLY:
Landlord Name, Address and Phone Number provided in Section B
Income Information (Section E & F) - Verify that all required fields are completed.
Applicant Affirmation (Section G)
Read and sign
Attachment 1 – Frequently Asked Questions and Personal Privacy Protection Law Provisions
Keep for your records
Please return application via one of the following methods:
1) Mail: EmPower New York
2) Fax: 315-463-7393
P.O. Box 2489
3) Email:
Syracuse, NY 13220-2489
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