Massachusetts Discount Rate Electric Application
This form has been moved to
https://www.nationalgridus.com/Discount-Rate-App-MA
.
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Yes,
I would like to apply for National Grid’s Low Income Discount Rate and agree to the following statement: I authorize the agency(s) providing my benefits to release information to National Grid for the purposes of enrollment and annual recertification for the Discount Rate and to notify the company if my benefits are discontinued. I also understand that I must notify National Grid if my benefits are discontinued.
Fields with an asterisk symbol (*) indicate required information. *
Customer Information
Customer Name:
Address:
City:
State:
Zip Code:
Email:
Account Number:
Phone:
Eligibility Criteria for the Discount Rate:
You are a residential customer (primary dwelling only),
Your electric bill is in your name,
And either you are eligible for the low-income home energy assistance program (LIHEAP), or its successor program, for which eligibility does not exceed 200% of the federal poverty level based on a household’s gross income. In a program year in which maximum eligibility for LIHEAP exceeds 200% of the federal poverty level, a household that is income eligible under LIHEAP shall be eligible for the low-income electric discount.
Or you are currently receiving benefits under one of the following means-tested programs.
I Receive Benefits From the Following Program:
(Choose one)
Emergency Aid to Elders, Disabled, and Children (EAEDC)*
Food Stamps (SNAP)*
Head Start*
MassHealth (Medicaid)*
National School Lunch Program*
Public Housing*
School Breakfast Program*
Supplemental Security Income (SSI)*
Transitional Aid to Families with Dependent Children (TAFDC)*
Veterans’ Service Benefits* (Chapter 115)
Veterans DIC Surviving Parent or Spouse*
Veterans Non-Service* Disability Pension
Fuel Assistance*
Women, Infants and Children (WIC)
*Please attach photo proof of benefits using the
Choose File
button below. Acceptable forms of proof include a program I.D. card or a copy of the certifying agency's acceptance letter.
Attach Required Proof of Benefits Documentation
Attach photo proof for
Emergency Aid to Elders, Disabled, and Children (EAEDC)
Attach proof for
Food Stamps (SNAP)
Attach photo proof for
Head Start
Attach photo proof for
MassHealth (Medicaid)
Attach photo proof for
National School Lunch Program
Attach photo proof for
Public Housing
Attach photo proof for
School Breakfast Program
Attach photo proof for
Supplemental Security Income (SSI)
Attach photo proof for
Transitional Aid to Families with Dependent Children (TAFDC)
Attach photo proof for
Veterans’ Service Benefits (Chapter 115)
Attach photo proof for
Veterans DIC Surviving Parent or Spouse
Attach photo proof for
Veterans Non-Service Disability Pension
Attach photo proof for
Fuel Assistance
Attach photo proof for
Women, Infants and Children (WIC)
I certify that all of the information provided on this application is true. I receive benefits from the program indicated and the National Grid residential account above is in my name, and I am income eligible. *
Check the "I'm not a robot" reCAPTCHA, then click the button below to verify the documentation and add your electronic signature.