Customer Assistance Programs Online Form

Thank you for your interest in UGI’s Customer Assistance Programs. To help us determine which programs you may be eligible for, identify your household weekly gross (before taxes) income level in the chart below and complete the form.

	Number of People Living in Your Household
Weekly Income Level	1	2	3	4	5	6	7	8
Level 1	$451 or Less	$610 or Less	$769 or Less	$927 or Less	$1,086 or Less	$1,245 or Less	$1,403 or Less	$1,562 or Less
Level 2	$452 – $602	$611 – $813	$770 – $1,025	$928 – $1,237	$1,087 – $1,448	$1,246 – $1,660	$1,404 – $1,871	$1,562 – $2,083
Level 3	$603 – $752	$814 – $1,017	$1,026 – $1,281	$1,238 – $1,546	$1,449 – $1,810	$1,661 – $2,075	$1,872 – $2,339	$2,084 – $2,603

Please allow 15 business days for UGI to respond to your online inquiry.

Name on UGI Account

Last 4 Digits of UGI Account Number

Service Address

Service Address City, State, Zip Code

Number of People in Household

Please select your household income based on chart above

Level 1 Level 2 Level 3

Is there a particular program you are interested in? Select all that apply.

CAP LIURP Operation Share LIHEAP

What to Expect After Submitting this Form:

UGI will review your form submission.
If your account is eligible to take advantage of assistance programs, UGI will send you the appropriate paperwork required for enrollment into the program. Accounts that purchase their gas from another supplier, are coded landlord/tenant, foreign load, or a health care facility do not qualify.
You will be notified by UGI or the Community-Based Organization if your application is approved.
Please allow two to four weeks for the above process.

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Customer Assistance Programs Online Form

What to Expect After Submitting this Form: