Ameren Missouri Energy Assistance – Keeping Current is sponsored by Ameren Missouri. Monthly bill assistance program for eligible Ameren Missouri customers, including credit and past‑due forgiveness.

1. Complete the application below. If your application is not complete, it may be delayed or denied.

2. Include the required documentation. Applications missing documentation will have ten days to provide.

– Copies of current electric and gas bill – Proof of income for all household members (paystubs from all employers with pay dates for prior month, current award letters, child support and current pension) – Proof of social security number and proof of identification 3. Take or send your completed application to the agency near you. (List below.)

A list of agencies can be found on the last page of the application. 4. You will be contacted once your application has been reviewed and processed.

HAVE YOU APPLIED FOR LIHEAP THIS PROGRAM YEAR? Yes No APARTMENT/UNIT NUMBER (if applicable) EMAIL CITY, STATE, ZIP CODE PHONE NUMBER SOCIAL SECURITY NUMBER GENDER Female Male I wish not to answer DATE OF BIRTH EMPLOYMENT STATUS (check one) Employed Unemployed Retired HOUSEHOLD SIZE (indicate the number of adults and minors permanently living in your home) Total Number in Household – Is anyone in the household 5 or under?

Yes No – Is the residence public housing? Yes No – Is anyone in the household 60 or older? Yes No – Anyone in the household chronically ill?

Yes No – Is anyone in the household permanently disabled? Yes No AMEREN ACCOUNT NUMBER (provide all 10 digits) How do you heat your home?

(Check one) Electric Natural Gas or Other Source – You must pay a down payment of 1/12th of your total account balance (can be by pledge or customer payment) – You must pay by the due date each month – You will be enrolled in a Budget Billing payment agreement – You will receive a monthly bill credit for 12 months – Your past due balance will be forgiven over 12 months – Three missed payments over 12 months will remove you from the program Keeping Current, Keeping Cool Application for Assistance Review the consent statement before signing in black or blue ink.

CONSENT STATEMENT: I declare that the information I have given is true, correct, and complete to the best of my knowledge. I realize that the information which I have given on this application will need to be verified by the agency processing this application. I hereby authorize the agency processing this application to release information relating to my application to my fuel supplier to determine if I am eligible.

I understand that I may be fined, imprisoned, or both under state and federal law if I make false statements on this application to get assistance that I am not eligible to receive. Provide a copy of this page to the customer after it has been signed and dated by both parties. MAKE MANAGING YOUR ENERGY USE EASY BY TAKING THESE SIMPLE ACTIONS: Create an online account at AmerenMissouri.

com Download the Ameren app from the app store on your mobile device. Enroll in paperless billing from your online account. Choose the date your bill is due each month at AmerenMissouri.

com/PickADueDate Register for text alerts. Text REG to AMEREN (263736) Register for email alerts from your online account. Apply for Weatherization Assistance.

KEEPING CURRENT/COOL AGENCIES • Audrain County Shelter Resource Coalition • Better Family Life • Central Missouri Community Action Agency • Community Action Agency of St. Louis County (CAASTLC) • Community Action Partnership of Greater St.

Joseph • Community Action Partnership of Northeast Missouri (CAPNEMO) • Delta Area Economic Opportunity Corporation (DAEOC) • Doorways • East Missouri Action Agency • Good Samaritan Center • Green Hills Community Action Agency • Jefferson Franklin Community Action Corporation • Missouri Ozarks Community Action, Inc. (MOCA) • Missouri Valley Community Action Agency (MVCAA) • New Madrid County Family Resource Center • North East Community Action Corporation Admin Office (NECAC) • Nurses for Newborns • People’s Community Action Corporation (PCAC) • Salvation Army (Arnold, Chillicothe, Kirksville, STL City, and STL County locations) • Salvation Army Center of Hope • St.

Louis City Housing Authority • Sts. Joachim and Ann Care Service • St. Patrick Center • The United Way of Greater St.

Louis, INC. • Urban League (Peter Bunce, STL City, and Jennings North STL County) • West Central Missouri Community Action Agency 1) Program: Keeping Current Keeping Cool NOTE: The applicant may participate in either Keeping Current or Keeping Cool; but not both at the same time . 2) Did you verify income documentation?

Yes No* NOTE: If no, the applicant must provide income documentation for all household members before their eligibility can be determined.

3) Applicant’s Total Monthly Household Income: 4) Poverty Level Keeping Current: 0-150% FPL 151-200% FPL Keeping Cool: 0-250% FPL NOTE: If the applicant is up to 200% FPL, it is recommended that they also apply for: LIHEAP Weatherization 5) Referral to Weatherization Agency (if applicable) Yes No Poverty Level Chart by Household Size and Monthly Income Keeping Current/Cool 6) Provide the applicant a copy of the Program Information Flyer regarding Keeping Current, Keeping Cool, Pick A Due Date, Weatherization and LIHEAP.

> People in Your Household (#) Keeping Current Keeping Cool > up to 200% of Federal Poverty Level up to 250% of Federal Poverty Level 1$2,608 $3,260 2$3,525 $4,406 3$4,442 $5,552 4$5,358 $6,698 5$6,275 $7,844 6$7,192 $8,990 7$8,108 $10,135 8$9,025 $11,281