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Circle ALL types of household income A. TANF N. Worker s Compensation B. Social Security C. SSI Q. Child Support or Alimony D. Applicant s Signature OR Mark Date Witness to Mark or Interpreter Phone Number Completed on behalf of applicant by Phone Number. Has your household received a shutoff notice for electricity YES E. Baseboard Heat K. None L. Unknown If yes when will your electric service be disconnected If yes when did your electric service end APPLICANT S CERTIFICATION I certify that...
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What is agency use only?
Agency use only is a section on a form or document that is intended for internal use by the agency or organization to which the form belongs.
Who is required to file agency use only?
Only employees or authorized personnel of the agency or organization are required to fill out the agency use only section.
How to fill out agency use only?
To fill out the agency use only section, employees or authorized personnel must provide any internal information or notes that are relevant to the agency or organization.
What is the purpose of agency use only?
The purpose of agency use only is to keep internal information confidential and separate from information that is meant to be shared externally.
What information must be reported on agency use only?
Any internal communications, notes, or information that is relevant to the agency or organization's operations may be reported in the agency use only section.
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