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Landlord Affidavit for Energy Assistance Program

Landlord Affidavit for Energy Assistance Program 2026

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The document is an affidavit for landlords to complete on behalf of tenants applying for the Energy Assistance Program (EAP) in Indiana. It collects information about the applicant, utility costs, and the landlord's permission to access utility data. The form must be filled out accurately to ensure the tenant's eligibility for energy assistance benefits.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Applicant Information' section. Enter the applicant's name, date, address, phone number, city, state (IN), and zip code.
Proceed to the 'Utility Information' section. Indicate who is responsible for heating and electric costs by checking the appropriate boxes. If applicable, provide a utility statement copy.
Complete details about the primary heat source and number of household members. Specify if the primary heat source is not working and select the dwelling type.
In the final section, print and sign your name as the landlord, along with your address, date, city, phone number, state, zip code, and optional email.

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See more Landlord Affidavit for Energy Assistance Program versions

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Versions	Form popularity	Fillable & printable
2019	4.9 Satisfied (21 Votes)
2017	4.2 Satisfied (28 Votes)
2016	4.5 Satisfied (60 Votes)

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