Required Information - No Exceptions

PROVIDE COPIES ONLY - NO ORIGINALS

NOTE:  Make your own COPIES of any required documents BEFORE arriving at GSN. Missing documents will DELAY the process and postponed receipt of your application.

​​

GOOD SAMARITAN NETWORK OF HAMILTON COUNTY is your local service provider.

​

Please submit your application to Good Samaritan Network - who is administering EAP on behalf of Area IV in Hamilton County.

​

•     If you do not know who your local service provider is, you may identify them by dialing 2 -1-1 or by visiting http://eap.ihcda.in.gov. It should also be listed on the front of the application.

​

•     Please submit the following documents with your application (copies ONLY):

​ 

If you drop off or mail in a paper application, please complete it completely. Make sure all sections and questions are answered. On page 2 of the application, make sure to answer whether or not your heating source is working. 

ALL applications (whether online or in person) MUST have the following documentation. Failure to provide documentation will delay the processing of your application. Failure to provide documentation in 14 calendar days could cause your Energy Assistance Application to be denied.

​

1. Income documentation for ALL household members age 18 or older. 

2. Last pay stub received if you have worked at your current job for the last 3 months. If you have not worked at your current job all 3 months then proof of income for all 3 months is required. If you have not worked at your current job for all 3 months, start date of your current job is needed.

3. For Social Security income – a current SS or SSI Benefit letter (letter must be dated within the last 3 months). You can also provide a current bank statement that has not been altered in any way. Bank statements must show the client’s name, dates, and amount deposited.

4. Pension – A pension statement is needed. You can use a bank statement with no alterations made if no taxes are taken out of your pension. Bank statements must show the client’s name, dates, and amount deposited.

5. School Schedule—A copy of the current school schedule is required for household members age 18 and up who are still in school. A college student must be taking at least 12 credit hours. School Schedules must show the student's name, school name, full-time status, and class information.

6. No Income – if you have NOT worked in the last 3 months OR you are paid in cash, OR you work odd jobs, you may fill out an Income Verification Form as proof of income.  Income Verification forms MUST BE signed by the person using the form as income.  If you are employed AND receive pay stubs (even if they are online), you CANNOT use the Income Verification Form. 

7. If you are renting and one or both utilities are included in the month's rent, the Landlord affidavit must be completed and signed by the Landlord. You will also need to fill out a Direct Benefit Payment form.

8. Copies of CURRENT utility bills—If you heat with gas, both your gas and electric bills are required. You must include ALL pages of the utility bills. 

9. If a utility bill is in the name of someone not living in the household, you must fill out a Utility Affidavit. This includes a household member with a different last name, i.e. a female head of household using a maiden or another name.

If any items are missing from your application, you will receive a Missing Documents Letter either in regular mail or an email.
 

Depending on household circumstances, additional documentation may be required.

​