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FORMS AND APPENDICES Appendix A List of Manual Changes Appendix B Local Service Providers (LSPs) Appendix C IHCDA Community Programs Contacts Appendix D Federal LIHEAP Statute Appendix E Indiana Moratorium Legislation Appendix F Income Calculation Quick Reference Chart Client-Facing Forms

Form ADDR-2026 Address Change Form Form APPL-2026 EAP Application Form Form APPLLP-2026 EAP Application Form – Large Print Form DBPE-2026 Direct Benefit Payment Election Form Form DIS-2026 Disability Medical Statement Form DWD-2026 Department of Workforce Development Release of Information Form EARN-2026 Request for Earnings Information Form EBTR-2026 Energy Benefit Transfer Request Form NHMD-2026 Non-Household Member Declaration Form TVS-2026 Tenant Verification Statement Form UFAIR-2026 Utility/Fuel Account Information Request Form UIV-2026 Undocumented Income Verification Form MTRX-2026 EAP Benefit Matrix Form Agency-Facing Forms Form EBTR-2026 Energy Benefit Transfer Request Form MTRX-2026 EAP Benefit Matrix Form Form ENRE-2026 Enhanced Application Review Form