Home Energy Emergency Assistance Scheme (HEEAS) application form

Use this form to submit your application for the Home Energy Emergency Assistance Scheme (HEEAS).

Before you complete this form, you must contact your electricity or reticulated natural gas supplier to start the application process and get a reference number to use in this form.

If you need help completing this application, please contact Concession Services on 13 QGOV (13 74 68) (local call charge) or (07) 3022 0801. If you require an interpreter, please telephone 131 450.

Required fields are marked with an asterisk (*).

Eligibility

Please select one of the following options *
Select your concession card type/s *

Reason for your application

For your application to be considered, the reason you select must have happened in the last 12 months.

Why are you applying for HEEAS? *

Please note: We may ask you for documents to verify the information you provide below.

Please complete if your household income has decreased substantially Only select those that apply to you.
Decrease in Centrelink benefits
Marriage/de facto separation
Housemate or family member moved out
Death of immediate family member
Child maintenance stopped or decreased
Decrease in hours of work
Loss of employment

Please note: We may ask you for documents to verify the information you provide below.

Please complete if you have had high unexpected expenses on essential items Only select the expenses that apply to you.
Refrigerator repair or purchase

Payment Plan or Finance fortnightly payment details.

Washing machine repair or purchase

Payment Plan or Finance fortnightly payment details.

Hot water service repair or purchase (not water charges)
Car repairs, not including registration or services
Direct funeral expenses, not including travel
Removalist expenses
One off medical expense(s) not covered by Medicare (including dental and optical)
Other unexpected expenses

Expenses such as telephone, water, rates, school expenses and other expected bills will not be considered.

Declaration

You must agree to the following before we can process your application:

  1. I consent to the Queensland Government asking Centrelink and/or Department of Veterans’ Affairs to determine and confirm my concession card status.
  2. I declare that all information I have given is true and correct and I understand that any fraudulent information provided in the application to obtain this assistance may lead to prosecution.
  3. I authorise the release of information regarding my energy account by the energy provider to the Queensland Government for purposes of assessing my application under the Home Energy Emergency Assistance Scheme.
  4. I authorise for any assistance provided to be paid directly to the energy provider.

Tick this box to indicate you have read and agree with the declaration above *

Did you get any help to complete this form?

Please include thier contact details below.

We will need to contact you for further information about your application, please provide your preferred contact details below. *

To receive an email acknowledgement, please provide your email address.

Your eligibility for assistance under the scheme will be determined on the information you have provided on this application form. Assistance cannot be provided if your reason outlined on the application is outside the scheme’s eligibility criteria. Please ensure you have accurately completed all the required information.
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