How to Fill Out and Submit the DC Zero Income Affidavit

A DC zero income affidavit is a sworn, agency-specific form you sign to confirm no one in your household is receiving money from any source. Three District agencies use their own version: the DC Housing Authority (DCHA) uses a Zero Income Statement for housing vouchers and public housing, the Department of Energy and Environment (DOEE) uses a Zero Income Affidavit for energy assistance programs, and the Department of Human Services (DHS) may ask for a sworn statement when processing SNAP or TANF. Download the form that matches your program, fill it out, notarize it if required, and submit it with your application.

Pick the Right Form for Your Program

The forms are not interchangeable. A DCHA statement will not substitute for a DOEE affidavit, and vice versa.

DCHA Zero Income Statement — required from every adult household member (18 and older) with no income, at initial application and at annual recertification for the Housing Choice Voucher program.¹²
DOEE Zero Income Affidavit — required for the Low Income Home Energy Assistance Program (LIHEAP), the Utility Discount Program, Weatherization, Emergency Mechanical Systems Replacement, and Solar for All. The LIHEAP application points zero-income households directly to the form.³⁴
DHS (SNAP, TANF) — DHS lists pay stubs, pension statements, and similar records on its eligibility documents page rather than a standalone zero income affidavit. If you have no income to document, ask your caseworker whether a sworn statement or self-attestation is accepted for your program.⁵

Where to Download the Forms

Both agency forms are free PDFs. The DCHA Zero Income Statement is on the Housing Voucher Application Forms page at dchousing.org.² The DOEE Zero Income Affidavit is on doee.dc.gov, and the LIHEAP application page links to it directly.⁶

Filling Out the DCHA Zero Income Statement

The form is one page. You provide your full legal name as it appears on your Social Security card, the last four digits of your Social Security number (or check the box indicating you do not have one), your signature, and the date.¹

You are not asked how you cover rent or food. You are asked to certify that you receive nothing from any of the listed income categories: hourly or salaried work, self-employment, unemployment benefits, temporary or contract work, TANF, Social Security, disability, retirement income, alimony, workers’ compensation, child support, veteran’s benefits, scholarships, or any other regular money.¹ If you receive anything in any of those categories, you cannot sign this form. Each adult in your household with no income fills out a separate copy.

Filling Out the DOEE Zero Income Affidavit

The DOEE version lists ten income categories you must certify as zero: employment wages (including commissions, tips, and bonuses), business income, rental income, interest or dividends, Social Security or pension payments, unemployment or disability payments, public assistance, periodic allowances such as alimony or child support, financial contributions from any person or entity, and any other source not named. You sign under a statement acknowledging that willful misrepresentation is punishable by law and authorizing DOEE to verify what you reported.⁶ Attach the completed affidavit to the program application it belongs with and follow that application’s submission instructions.³

Getting It Notarized

The DCHA Zero Income Statement must be notarized before you submit it.¹ Do not sign the form until you are in front of the notary. The DOEE affidavit does not require notarization on its face, but your program contact may still ask for it, so check before you submit.

Under DC law, the notary has to identify you through personal knowledge or satisfactory evidence.⁷ Satisfactory evidence means a current government-issued photo ID; the statute specifically lists a passport, driver’s license, or government-issued non-driver ID card. If you have no photo ID, a credible witness personally known to the notary can vouch for you under oath.⁸

Remote online notarization is also allowed in DC. A notary can witness your signature over audio-visual technology using at least two types of identity proofing, and the session is recorded.⁹

For a free notary, the Martin Luther King Jr. Memorial Library in downtown DC offers walk-in notary service on the second and third Saturdays of each month, first-come, first-served. Many banks and credit unions also notarize at no charge for account holders.

Where to Submit

DCHA. Voucher participants and waiting-list households can upload documents through DCHA’s RentCafe portal, or deliver them by mail or in person. Check your recertification notice or the DCHA resources page for the current mailing address.¹⁰
DOEE. Attach the affidavit to your program application and submit both together using that application’s instructions.³
DHS. Bring documentation to any DHS Service Center; the agency’s locator lists current locations and hours.¹¹

Keep a copy of every notarized original and any submission receipt or upload confirmation. If a document is lost in processing, a copy saves you from paying for a fresh notarization.

Recertification and Reporting Changes

A zero income affidavit is not permanent. If you still have no income, DCHA requires a new notarized statement every 180 days, and you have to report any change in income within 30 days.¹ Missing a recertification or failing to report new income can cost you your voucher.

SNAP reporting works differently. Simplified reporting households must report income changes no later than 10 days from the end of the month in which the change happened. If the change occurs with fewer than 10 days left in the month, you have 10 days from that point. A report is only required if your gross monthly income exceeds the limit for your household size; an increase that stays under the limit does not have to be reported.¹²

DOEE energy programs generally run on an annual application cycle, so you submit a new affidavit each time you reapply.

Penalties for False Statements

Signing a zero income affidavit when you actually have income is perjury under District law. A perjury conviction carries up to 10 years in prison.¹³ For an offense punishable by up to 10 years, the maximum fine under the District’s general schedule is $25,000.¹⁴

Agencies also cross-check what you report. DCHA’s form warns that it will run an income verification check and that inaccurate or incomplete information can cost you your voucher and lead to fines or imprisonment.¹ The DOEE form authorizes the same kind of verification.⁶ If a database check turns up a pay stub, unemployment deposit, or Social Security payment you did not disclose, you lose the benefit and face possible prosecution.

1
District of Columbia Housing Authority. DCHA Zero Income Statement
2
District of Columbia Housing Authority. Housing Voucher Application Forms
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Department of Energy and Environment. DOEE Income Statement
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Department of Energy and Environment. LIHEAP Application
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Department of Human Services. Documents You May Need to Determine Eligibility
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District of Columbia Department of Energy and Environment. DOEE Zero Income Affidavit
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D.C. Law Library. District of Columbia Code 1-1231.04 – Requirements for Certain Notarial Acts
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D.C. Law Library. District of Columbia Code 1-1231.06 – Identification of Individual
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D.C. Law Library. District of Columbia Code 1-1231.13a – Notarial Act Performed for Remotely Located Individual
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District of Columbia Housing Authority. Resources – District of Columbia Housing Authority
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Department of Human Services. Find a Service Center Near You
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Department of Human Services. SNAP Ongoing Eligibility Requirements
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D.C. Law Library. District of Columbia Code 22-2402 – Perjury
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D.C. Law Library. District of Columbia Code 22-3571.01 – Fines for Criminal Offenses