Low Income Radon Mitigation Assistance Program Homeowner Application

Attention: Before you begin this form, please prepare the documents listed below. These documents must be submitted to the LIRMA program to complete your application.

  • Radon test results > 4 pCi/L in the home within 12 months of application.
  • Proof of home ownership – copy of a Warranty Deed or Deed of Trust.
  • Copy of a current mortgage statement.
  • Copy of homeowners’ previous years Federal Income Tax Form filed with the Internal Revenue Service (IRS) or other income verification.
  • Copy of a current Colorado Driver’s License, Identification Card or Military Identification Card for each person on the deed to the home.
* Red star indicates a required field.

Household information:
Please enter 0 if none.

Property information:
1. Type of dwelling
2. One-to-four unit building
3. Foundation type


7. Please check here if your home is under the governance of a homeowners association (HOA). 
    If yes, you will need an approval of the mitigation plan from the HOA.

The undersigned does hereby certify that all information above is true, accurate and complete; and does hereby authorize the Colorado Department of Public Health and Environment to make independent investigations necessary to verify any information provided on the application form. The applicant also understands that the Colorado Department of Public Health and Environment does not accredit, certify, recommend or endorse individual contractors and is not responsible for work done or liability incurred by the individuals.

For the purposes of this form, the Colorado Department of Public Health and Environment accepts your typed name and date as an electronic signature equivalent to your valid signature on a paper copy of the form. As such, this electronically completed form bears the same rights and responsibilities as a hand-signed form.