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can subsequently assist the applicant with getting the bill changed into his/her name by advocating with the energy vendor.

Source: Miss. Code Ann § 43-1-2(4); Miss. Code Ann. § 43-1-4. Revised: January 2026

Rule 6.9 Authorization of Release of Information

Applicant should sign the “Authorization of Release of Information Form” (Form ARF-001) annually to authorize the energy vendor(s) to release household energy usage and billing data to the subgrantee for purposes of reporting this data in the LIHEAP Performance Measures Report required by the Department of Health and Human Services. The subgrantee shall advise the applicant that refusal to sign this form will prevent the subgrantee from being able to retrieve the applicant’s utility bills from the vendor. LIHEAP benefits cannot be denied to the applicant for refusal to sign this form. However, subgrantees must list the applicant’s name on a report to be submitted to MDHS requesting the applicant’s information not be included in the federal report.

Source: Miss. Code Ann. § 43-1-2(4); Miss. Code Ann. § 43-1-4. Revised: January 2026

Rule 6.10 Affidavits

Affidavits are written declarations made under oath before a notary public or other authorized officer. Agencies should have a staff member who is a notary, and clients should not be charged. Affidavits are valid for thirty (30) days. Affidavits are to be obtained for the following reasons:

A. Authorized Representative applying for services on behalf of an applicant: The representative must have an affidavit giving authority to act on behalf of the applicant. Original copies of documents required for eligibility must be presented. If the representative has a Power of Attorney, an affidavit is not required. The Power of Attorney must be scanned into Virtual ROMA. B. Separation: The State of Mississippi does not recognize legal separation. Applicants must obtain an affidavit which declares separation from the spouse. C. Zero income household: Applicant must obtain an affidavit when declaring zero income for the entire household. D. Unemployed: For each adult (18 years of age and older) that lives in the household, has no income and is not a student, an affidavit must be obtained confirming unemployment status for thirty (30) days. E. Guardianship: If the applicant reports guardianship over any minors (grandchildren, nieces, nephews, etc.) in their home, an affidavit MUST be completed AND the applicant must obtain official documentation from a verifiable agency/source (CPS, attorney offices, school records, etc.) to confirm residency status of the child.