Weatherization Assistance Program Evaluation

OMB Control Number: _ _ _ _ - _ _ _ _

D10: ALL AGENCIES OVERVIEW DATA FORM

This data is being collected to choose a sample of local agencies to contact to evaluate client education, audit and other specific weatherization services.  The data you supply will be used select a small number of agencies for special process evaluation studies.

Public reporting burden for this collection of information is estimated to average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records Management Division, IM-11, Paperwork Reduction Project (1910-XXXX), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (1910-XXXX), Washington, DC  20503.

All of the information obtained from this data form will be protected and will remain confidential. The data will be analyzed in such a way that the information provided cannot be associated back to your state, your agencies, or the housing units and clients that your state served. Again, please note that the questions refer to PY 2008 unless otherwise noted.

1. What is the primary method that your agency used in Program Year 2008 to select weatherization measures for clients’ dwelling units (excluding health, safety, and repair measures and general heat waste measures)?

___ Priority list used for all dwelling units

___ Calculation procedure (e.g., spreadsheet, computerized audit) used for all dwelling units

___ Priority list applied to dwelling units meeting specified guidelines and calculation procedure used for remaining units

___ Other - Please specify: __________________________________________________

2. If your agency used a calculation procedure for at least some dwelling units, what was the name of the procedure or procedures employed. Check all that apply.

___ AK Warm

___ EA-3

___ EASY

___ EA-QUIP

___ HomeCheck

___ Meadows

___ REES

___ REM/Rate

___ SMOC-ERS

___ TIPS

___ TREAT

___ Weatherization Assistant (NEAT/MHEA)

___ WXEOR

___ Other – Please specify: ____________________________________________________

3. Which of the following client education approaches did your agency use in Program Year 2008? Check all that apply.

___ Provide literature at time of client intake

___ Provide video, CD, or DVD at time of client intake

___ Provide hardware kit at time of client intake

___ Prove in-person instruction at time of client intake

___ Provide literature at time of audit

___ Provide video, CD, or DVD at time of audit

___ Provide hardware kit at time of audit

___ Provide in-person instruction at time of audit

___ Provide literature at time of weatherization___

___ Provide video, CD, or DVD at time of weatherization

___ Provide hardware kit at time of weatherization

___ Provide in-person instruction at time of weatherization

___ Provide literature at separate client education visit

___ Provide video, CD, or DVD at separate client education visit

___ Provide hardware kit at separate client education visit

___ Provide in-person instruction at separate client education visit

___ Provide literature at time of inspection

___ Provide video, CD, or DVD at time of inspection

___ Provide hardware kit at time of inspection

___ Provide in-person instruction at time of inspection

___ Group training class

___ Other - Please specify: ____________________________________________________

4. From which of the following sources did your agency obtain needed skills and/or information in Program Year 2008? Check all that apply.

___ National Weatherization Program Conference

___ Affordable Comfort Conference

___ National Community Action Foundation (NCAF) Conference

___ National Association for State Community Services Programs (NASCSP) Energy

Leveraging Conference

___ Other national conference

___ Regional weatherization conference

___ State weatherization conference

___ Other state conference

___ State/regional training center class

___ Manufacturer’s training school class

___ Utility training class

___ State sponsored class taught at central location (e.g., local agency, state office)

___ Class not sponsored by state (e.g., another state, trade organization)

___ Visiting another agency

___ Instruction received by just your agency during a visit by state staff

___ In-person expert visit to your agency (e.g., peer exchange, consultant)

___ Web cast

___ Conference call

___ Phone call from expert

___ E-mail from expert

___ Other (please specify) _____________________________________________________

5. Which of the following types of post-weatherization quality control inspection did your agency perform in Program Year 2008? Check all that apply.

___ Visual inspection of installed measures

___ Verification of insulation depths/quantities

___ Verification of operation of measures installed

___ Assessment of quality of measures installed

___ Identification of needed measures that were not installed

___ Blower door test

___ Heating system efficiency test (flue gas analysis)

___ Draft/spillage tests of heating systems

___ Carbon monoxide (CO) monitoring

___ Infrared scanning

___ Identification of unresolved health and safety issues

___ Discussion with occupants

___ Use of customer sign-off form

___ Other (specify) __________________________________________________________