Form DOE F 540.2 Form DOE F 540.2 U.S. DOE Weatherization Annual File Worksheet

DOE F 540.2 OMB Control No. 1910-5127

Expiration Date: 11/30/2016

U.S. Department of Energy

WEATHERIZATION ANNUAL FILE WORKSHEET

Grant #: __________ State: ___________ Program Year: __________

Budget Period: __________________

IV.1 Subgrantees

Grantee	City	Tentative
		Funding*	Units*
Totals

* Funding can include non-DOE sources if included in DOE budget. Units can include those completed with non-DOE funding if included in the DOE budget.

IV.2 WAP Production Schedule

Number of Units (Excluding reweatherized)
Reweatherized Units

Average Unit Costs, including Reweatherization, Subject to DOE Program Rules*
VEHICLES & EQUIPMENT AVERAGE COST PER DWELLING UNIT (DOE RULES)
A Total Vehicles & Equipment ($5,000 or more) Budget
B Total Units Weatherized
C Total Units Reweatherized
D Total Dwelling Units to be Weatherized and Reweatherized (B+C)
E Average Vehicle & Equipment Acquisition Cost per Unit (A divided by D)
AVERAGE COST PER DWELLING UNIT (DOE RULES*)
F Total Funds for Program Operations**
G Total Dwelling Units to be Weatherized and Reweatherized (from line D)
H Average Program Operations Cost per Unit (F divided by G)
I Average Vehicle & Equipment Acquisition Cost per Unit (from line E)
J Total Average Cost per Dwelling (H plus I)

* Funding can include non-DOE sources if included in DOE budget. Units can include those completed with non-DOE funding if included in the DOE budget.

** Funds for program operations include expenditures described by 440.18(c)(1) through (9).

IV.3 Energy Savings

M ethod used to calculate energy savings: WAP algorithm: Other (describe below):

Other Energy Savings Method Description

This year estimated energy savings (MBtus): ________________

Prior year estimated energy savings (MBtus): ________________ Actual: ­­­­________________

U.S. Department of Energy

WEATHERIZATION ANNUAL FILE WORKSHEET (continued)

Grant #: __________ State: ___________ Program Year: __________

Budget Period: __________________

IV.4 DOE-Funded Leveraging Activities

IV.5 Policy Advisory Committee Members

IV.6 State Plan Hearings (Note: attach notes and transcript to the SF-424)

Hearing Date:	Newspapers that publicized the hearings and the dates that the notice ran.

IV.7 Miscellaneous

OMB Burden Disclosure Statement

Public reporting burden for this collection of information is estimated to average 3 hours 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 the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0043), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

U.S. Department of Energy

WEATHERIZATION ASSISTANCE PROGRAM

ANNUAL FILE WORKSHEET

INSTRUCTIONS

The Annual File Worksheet is designed to gather specific detail related to the expenditures of the Weatherization grant.

			Item		Explanation
IV.1		Subgrantees Grantee City Funding Units		Identify each intended subgrantee by name Identify the city in which the agency resides Identify the tentative funding each agency will receive Identify the tentative total of completed units anticipated by the agency with this funding
IV.2		Production Schedule Total Units Reweatherized Units Average Unit Costs, including Reweatherization, Subject to DOE Program /Rules		Calculate the total units expected to be weatherized for this program year, excluding reweatherized units Calculate the number of reweatherized units to be completed this program year. Enter data for and add and subtract, as specified to determine the average unit costs for units subject to DOE Program/Rules

IV.3	Energy Savings	Identify whether the states will use the WAP Algorithm or Other method to calculate the estimated energy savings; if other method, description must be entered Identify the actual estimated energy savings in MBtus attributed to this funding and program year
IV.4	DOE-Funded Leveraging Activities	State weatherization leveraging activities anticipated during this program year using DOE funding
IV.5	Policy Advisory Committee Members	Provide the names, groups, organizations, or agencies represented by the PAC members and a list of the PAC meeting(s) attendees
IV.6	State Plan Hearings	Identify the hearing date(s); a list of the newspapers that publicized the hearings including the dates the notices ran (notes, minutes, or transcripts should attached to the SF-424)
IV.7	Miscellaneous	Identify any anticipated activities that are not routinely administered as part of the Weatherization Assistance Program (e.g., disaster relief, energy crisis response)

Application Package 2013