PECO CAP No-Income Form: How to Complete, Submit, and Appeal

The PECO CAP No Income Form is a sworn statement you attach to a Customer Assistance Program application when no one in your household has any cash income. It takes the place of the pay stubs or benefit letters other applicants submit, and it explains to PECO how your household covers food, shelter, and other basics without a paycheck. You can download the English or Spanish version from PECO’s CAP page or request one by calling PECO customer service.¹

When This Form Is the Right One

Use the No Income Form only if no one age 18 or older in your household earns wages, receives government cash benefits, collects child support, or has any other source of cash income. If even one adult brings in any income at all, you submit standard proof instead — pay stubs, award letters, or bank statements — not this form.

SNAP does not count as cash income. If your household receives SNAP but no money, you still use the No Income Form and note the SNAP separately in the narrative section.

To qualify for CAP, total gross household income must be at or below 150 percent of the federal poverty level. For 2026, that threshold is $1,995 per month for one person, $2,705 for two, $3,415 for three, and $4,125 for four, with $710 added per additional person.² Zero income clearly falls under that limit, but PECO still needs the form as verification before enrolling you.

What to Gather Before You Start

p>Pull these together first so you can complete the form in one sitting:

A recent PECO bill, for the account number printed near the top.
Full legal names and dates of birth for every person living at the address, including children.
Social Security numbers for all household members.
The date the household’s last source of income ended — the last day of a job, the final unemployment payment, the month a benefit stopped.

Check that the names and Social Security numbers match what the Pennsylvania Department of Human Services has on file, particularly if anyone in the household receives SNAP or Medicaid. Mismatches between your form and DHS records are one of the more common reasons applications get held up.

Filling In the Form

The form asks for your PECO account number, the names of everyone in the household (not only the account holder), the date income stopped, and a clear declaration that the household currently has no income from any source. You sign and date at the bottom, certifying that everything on the form is true.

List every household member, even those who are not applying for benefits themselves. The headcount matters for how PECO reads the rest of the form.

The Narrative: How Your Household Gets By

This is where most applications stall. PECO reviewers need to see how a household with no income is keeping food on the table and a roof overhead, because that support has to come from somewhere. A one-line answer like “family helps” almost always triggers a follow-up request that adds weeks to processing.

Be specific. If a relative or friend helps, name them, say what they provide (cash, groceries, direct rent payments to the landlord), and give a rough amount and frequency. If you’re drawing down savings, say roughly how much is left and how long you expect it to cover you. If you use food banks, church pantries, or a shelter, list them by name — those are easy to verify and strengthen the application. If you receive SNAP, mention it here; it isn’t cash income, but it explains how the household eats.

Reviewers look for internal consistency. If the form says zero income and doesn’t explain how rent gets paid, it reads as incomplete. Three or four clear sentences covering food, shelter, and household expenses are enough. You aren’t writing an essay; you’re closing an obvious gap for the person reading the file.

Submitting the Form

Send the signed form along with your CAP application by any of these routes:

The Atlanta mailing address is correct. PECO’s CAP applications go through a centralized service center rather than a local Pennsylvania office. Fax gets the document into the queue immediately, and the online upload gives you the quickest confirmation of receipt.

Whichever route you use, keep a copy of the completed form and note the date you sent it. If you fax, print the transmission confirmation. That paperwork is your proof of when you applied if any question comes up later.

After You Submit

PECO notifies you by mail or email once a decision is made. Processing typically takes at least two to three weeks and can run longer if volume is high or if the eligibility team calls with follow-up questions about the narrative section.

Once you’re enrolled, first-time CAP participants may have their past-due balance forgiven entirely. Your ongoing bill is set as a percentage of household income. Because your household reports zero income, you pay the program minimum: $10 per month for standard electric service, $20 for electric heating, or $20 for gas.² If income comes into the household later, your CAP bill adjusts to match. Report changes to PECO promptly rather than waiting; the program recalculates your bill, it doesn’t remove you, and unreported income found later is a much bigger problem than an update.

If PECO Denies the Application

Most denials come down to a vague narrative, a blank field, or information that didn’t match PECO or DHS records. Call PECO first to find out the specific reason. Many denials clear up quickly with a resubmitted form that fills in what was missing.

If you believe the denial is wrong, you can file a written appeal. Include your name, address, PECO account number, the reason you’re appealing, and any documentation you didn’t send the first time. If the dispute can’t be resolved with PECO directly, you can file an informal complaint with the Pennsylvania Public Utility Commission, which can order corrective action if it finds the denial improper.

If your circumstances have changed since the denial — someone moved out, a benefit ended — reapply with the updated information rather than appealing the older decision.

This Is a Sworn Statement

The form is signed under penalty of law. Misrepresenting your household’s finances is grounds not only for losing CAP but for referral for public assistance fraud under Pennsylvania law. A fraud finding carries penalties of up to seven years in prison and fines up to $15,000, along with mandatory disqualification from the program and an order to repay benefits you weren’t entitled to.

The practical takeaway is simple: list everyone who lives with you, describe honestly how the household is surviving, and update PECO when things change. That’s what the form is there to capture.