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pdfOMB Control No. 0970-0449
OMB Control No. 0970-0449
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
Expiration Date: 03/31/21
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
MODULE 1 (LIHEAP Grantee Survey)
SECTION I. GRANTEE INFORMATION
Grantee Name:
Date:
Contact Person:
Expiration Date: 03/31/21
Phone Number:
SECTION II. REPORTING REQUIREMENTS
The 50 States and the District of Columbia are required to complete the LIHEAP Grantee Survey Section of the LIHEAP Performance Data Form in providing estimates of sources and uses of funds, average benefits, and the maximum
income cutoff in dollars for a 4-person household as of 10/1/16 for each type of LIHEAP assistance provided in FFY 2020.
Timely response to questions on this report is mandatory. The information will be used to respond to Congressional inquiries, to calculate LIHEAP benefit targeting, and to provide Federal Fiscal Year data for the Department's annual
LIHEAP Report to Congress that is required under Section 2610 of Public Law 967-35, as amended. The data are also used in measuring LIHEAP performance under the Government Performance and Results Act (GPRA) of 1993, as
amended by the GPRA Modernization Act of 2010. As the reported data are aggregated, the information in this report is not considered to be confidential.
SECTION III. ESTIMATED SOURCES OF LIHEAP FUNDS
ALL OF FFY 2020 10/1/2019 TO 9/30/2020)
Amount Rounded to the Nearest Dollar
A. All Funds Except CARES Act and other Supplemental Funding (Items 1-9)
1. FFY LIHEAP Block Grant Allotment (Net of Indian Tribal Set-Asides)--regular funds
$0
2. FFY Emergency Contingency Funds (Net of Indian Tribal Set-Asides)
$0
3. LIHEAP Block Grant Funds from Previous FFY Reallotted to FFY
$0
4. Previous FFY Unobligated Emergency Contingency Funds, not Subject to 10% Carryover Limit
$0
5. All Funds Carried Over From Previous FFY (except Funds in item 4 and 9 in this Section)
$0
6. Petroleum Violation Escrow (Oil Overcharge) Funds Obligated in FFY
$0
7. FFY Residential Energy Assistance Challenge (REACH) Program
$0
8. FFY Leveraging Incentive Award
$0
9. Previous FFY Leveraging Incentive Award obligated in FFY
$0
B. Estimated Subtotal Sources of Funds--Non-CARES/Supplemental Funding
10. Sum of Items 1-9. This should equal the sum in Section IV. Column D, Item 14.
$0
C. All Supplemental Funds (Items 11-13)
11. CARES Act Allotment (Net of Indian Tribal Set-Asides). This should equal the sum in Section IV. Column D, Item 25
$0
12. [RESERVED, if applicable] Other Supplemental1 Allotment (Net of Indian Tribal Set-Asides). This should equal the sum in Section IV. Column D, Item 3
$0
13. [RESERVED, if applicable] Other Supplemental2 Allotment (Net of Indian Tribal Set-Asides). This should equal the sum in Section IV. Column D, Item 4
$0
D. Estimated Subtotal Sources of Supplemental Funds
14. Sum of Items 11-13. This should equal the sum in Section IV. Column D, Item 48.
$0
E. Estimated Total of Sources of All Funds
15. Item 10 plus Item 14. This should equal the sum in Section IV. Column D, Item 49.
[ADMIN_LIHEAP_CARESActRevisedLPDF_FY2020.xlsx]LIHEAP Grantee Survey!
$0
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OMB Control No. 0970-0449
OMB Control No. 0970-0449
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
Expiration Date: 03/31/21
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
MODULE 1 (LIHEAP Grantee Survey)
Grantee Name:
SECTION I. GRANTEE INFORMATION
Date:
Expiration Date: 03/31/21
Contact Person:
Phone Number:
SECTION II. REPORTING REQUIREMENTS
The 50 States and the District of Columbia are required to complete the LIHEAP Grantee Survey Section of the LIHEAP Performance Data Form in providing estimates of sources and uses of funds, average benefits, and the maximum
income cutoff in dollars for a 4-person household as of 10/1/16 for each type of LIHEAP assistance provided in FFY 2020.
Timely response to questions on this report is mandatory. The information will be used to respond to Congressional inquiries, to calculate LIHEAP benefit targeting, and to provide Federal Fiscal Year data for the Department's annual
LIHEAP Report to Congress that is required under Section 2610 of Public Law 967-35, as amended. The data are also used in measuring LIHEAP performance under the Government Performance and Results Act (GPRA) of 1993, as
amended by the GPRA Modernization Act of 2010. As the reported data are aggregated, the information in this report is not considered to be confidential.
SECTION IV. ESTIMATED USES OF LIHEAP FUNDS
All of FFY 2020 (10/1/2019) to 9/30/2020)
Amount Rounded to the Nearest Dollar
A. Type of LIHEAP Assistance--Non-Supplemental Funds (Items 1-4)
Total Funds/Awards
Average Household Maximum Annual Dollar Income for 4Person Household as of the effective
Benefit
1. Heating Assistance Benefits--non-supplemental funds
$0
$0
$0
2. Cooling Assistance Benefits--non-supplemental funds
$0
$0
$0
3. Crisis Benefits by Type--non-supplemental funds
a. Winter Crisis Benefits--non-supplemental funds
b. Summer Crisis Benefits--non-supplemental funds
c. Year-round Crisis Benefits--non-supplemental funds
d. Other Crisis Benefits--non-supplemental funds
(1) Specify--non-supplemental funds
(2) Specify--non-supplemental funds
(3) Specify--non-supplemental funds
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
4. Weatherization Assistance Benefits--non-supplemental funds
$0
All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)--non-supplemental funds
$0
Bill Payment-Assisted Household Main Fuel
All Households
Natural Gas
Electricity
Fuel Oil
Propane
Other Fuels
5. Average Annual Total LIHEAP Benefit per Household (including Heating, Cooling, Crisis, Supplemental Benefits)--non-supplemental funds
B. Other Permitted Uses of LIHEAP Funds--non-supplemental funds (Items 6-13)
6. Nominal Payments--non-supplemental funds
$0
7. FFY Unobligated Funds (excluding funds in Items 8 & 9) Carried Over to next FFY--non-supplemental funds
$0
8. FFY Allowable Unobligated Emergency Contingency Funds, not Subject to 10% Carryover Limit, Obligated in next FFY
$0
9. FFY Leveraging Incentive Award Obligated in next FFY
$0
10. FFY LIHEAP Block Grant Allotment Used to Identify, Develop & Demonstrate Leveraging Incentive Activities--non-supplemental funds
$0
11. Assurance 16 Activities--non-supplemental funds
$0
12. FFY Residential Energy Assistance Challenge (REACH) Program
$0
13. Administration/Planning Costs--non-supplemental funds
$0
C. Estimated Total Uses of Funds--non-supplemental funds
14. Sum of Items 1-4 and 6-13. This should equal the sum in Section III. Column D, Item 10.
$0
Q1. Obligated funding for a given type of assistance in current FFY, but will serve households in the subsequent FFY--regular funds
yes/no
Q2. Average Household Benefits are estimated due to unique program operation, rather than directly calculated--regular funds
yes/no
[ADMIN_LIHEAP_CARESActRevisedLPDF_FY2020.xlsx]LIHEAP Grantee Survey!
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OMB Control No. 0970-0449
OMB Control No. 0970-0449
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
Expiration Date: 03/31/21
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
MODULE 1 (LIHEAP Grantee Survey)
Grantee Name:
SECTION I. GRANTEE INFORMATION
Date:
Expiration Date: 03/31/21
Contact Person:
Phone Number:
SECTION II. REPORTING REQUIREMENTS
The 50 States and the District of Columbia are required to complete the LIHEAP Grantee Survey Section of the LIHEAP Performance Data Form in providing estimates of sources and uses of funds, average benefits, and the maximum
income cutoff in dollars for a 4-person household as of 10/1/16 for each type of LIHEAP assistance provided in FFY 2020.
Timely response to questions on this report is mandatory. The information will be used to respond to Congressional inquiries, to calculate LIHEAP benefit targeting, and to provide Federal Fiscal Year data for the Department's annual
LIHEAP Report to Congress that is required under Section 2610 of Public Law 967-35, as amended. The data are also used in measuring LIHEAP performance under the Government Performance and Results Act (GPRA) of 1993, as
amended by the GPRA Modernization Act of 2010. As the reported data are aggregated, the information in this report is not considered to be confidential.
All of FFY 2020 (10/1/2019) to 9/30/2020)
Amount Rounded to the Nearest Dollar
D. Type of LIHEAP Assistance--CARES Act Funds (Items 15-18)
Total Funds/Awards
Average Household Maximum Annual Dollar Income for 4Person Household as of the effective
Benefit
15. Heating Assistance Benefits--CARES Act Funds
$0
$0
$0
16. Cooling Assistance Benefits--CARES Act Funds
$0
$0
$0
17. Crisis Benefits by Type--CARES Act Funds
a. Winter Crisis Benefits--CARES Act Funds
b. Summer Crisis Benefits--CARES Act Funds
c. Year-round Crisis Benefits--CARES Act Funds
d. Other Crisis Benefits--CARES Act Funds
(1) Specify--CARES Act Funds
(2) Specify--CARES Act Funds
(3) Specify--CARES Act Funds
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
18. Weatherization Assistance Benefits--CARES Act Funds
$0
All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)--CARES Act Funds
$0
Bill Payment-Assisted Household Main Fuel
All Households
Natural Gas
Electricity
Fuel Oil
Propane
Other Fuels
19. Average Annual Total LIHEAP Benefit per Household (including Heating, Cooling, Crisis, Supplemental Benefits)-- CARES Act Funds
E. Other Permitted Uses of LIHEAP Funds--CARES Act Funds (Items 20-24)
20. Nominal Payments--CARES Act Funds
$0
21. Unobligated CARES Act Funds Carried Over to next FFY
$0
22. FFY LIHEAP Block Grant Allotment Used to Identify, Develop & Demonstrate Leveraging Incentive Activities--CARES Act Funds
$0
23. Assurance 16 Activities--CARES Act Funds
$0
24. Administration/Planning Costs--CARES Act Funds
$0
F. Estimated Total Uses of Funds--CARES Act Funds
25. Sum of Items 15-18 and 20-24. This should equal the sum in Section III. Column D, Item 11.
$0
Q3. Obligated funding for a given type of assistance in current FFY, but will serve households in the subsequent FFY--CARES Act Funds
yes/no
Q4 Average Household Benefits are estimated due to unique program operation, rather than directly calculated--CARES Act Funds
yes/no
[ADMIN_LIHEAP_CARESActRevisedLPDF_FY2020.xlsx]LIHEAP Grantee Survey!
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OMB Control No. 0970-0449
OMB Control No. 0970-0449
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
Expiration Date: 03/31/21
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
Module II (Required LIHEAP Performance Measures)
Expiration Date: 03/31/21
V. ENERGY BURDEN TARGETING
Bill Payment-Assisted Household Main Fuel
All Households
Electricity
Natural Gas
Fuel Oil
Propane
Other Fuels
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
0
$0
$0
$0
$0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
D. Benefit Targeting Index for High Burden Households:
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
E. Burden Reduction Targeting Index for High Burden Households:
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
A. Unduplicated Number of LIHEAP Bill Payment-Assisted Households
Auto-Calculated
B. All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Unduplicated Number of Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)
Average Annual Household Income
Average Annual Total LIHEAP Benefit per Household (including Heating, Cooling, Crisis, Supplemental Benefits)
Average Annual Main Heating Fuel Bill
Average Annual Electricity Bill
Average Annual Total Residential Energy Bill
Average Annual Burden Before Receiving LIHEAP
Average Annual Burden After Receiving LIHEAP
Average Percentage Point Change in Energy Burden
Average Percentage Reduction in Energy Burden
C. High Burden Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Unduplicated Number of High Burden Households (Top 25%) with 12 Consecutive Months of Bill Data (Main Fuel and Electric)
Average Annual Household Income for High Burden Households
Average Annual Total LIHEAP Benefit per High Burden Household (including Heating, Cooling, Crisis, Supplemental Benefits)
Average Annual Main Heating Fuel Bill for High Burden Households
Average Annual Electricity Bill for High Burden Households
Average Annual Total Residential Energy Bill for High Burden Households
Average Annual Burden Before Receiving LIHEAP for High Burden Households
Average Annual Burden After Receiving LIHEAP for High Burden Households
Average Percentage Point Change in Energy Burden for High Burden Households
Average Percentage Reduction in Energy Burden for High Burden Households
0
0
0
0
0
VI. RESTORATION OF HOME ENERGY SERVICE
A. All Occurrences of LIHEAP Households that Had:
1. Energy Service Restored After Disconnection
2. Fuel Delivered to Home that Ran Out of Fuel
3. Repair/Replacement of Inoperable Home Energy Equipment
All Occurrences
Auto-Calculated
Auto-Calculated
Auto-Calculated
Energy Source (where LIHEAP benefit was applied)
Electricity
0
Natural Gas
0
0
0
Fuel Oil
Propane
Other Fuels
0
0
0
0
0
0
VII. PREVENTION OF LOSS OF HOME ENERGY SERVICE
Energy Source (where LIHEAP benefit was applied)
A. All Occurrences of LIHEAP Households that Had:
1. Past Due Notice or Utility Disconnect Notice
2. Imminent Risk of Running out of Fuel
3. Repair/Replacement of Operable Equipment to Prevent Imminent Home Energy Loss
NOTES:
All Occurrences
Auto-Calculated
Auto-Calculated
Auto-Calculated
Electricity
0
Natural Gas
0
0
0
Fuel Oil
Propane
Other Fuels
0
0
0
0
0
0
Include any notes.
VIII. CERTIFICATION FOR REQUIRED SECTIONS I. - VII.
1A. I certify to the best of my knowledge and belief that this report is correct and complete for Administration and Congressional oversight the program and for the purposes set forth in the award letter.
2A. Typed or Printed Name and Title of Authorized Certifying Official:
3A. Signature of Authorized Certifying Official: (click to sign)
[ADMIN_LIHEAP_CARESActRevisedLPDF_FY2020.xlsx]LIHEAP Performance Measures!
Date Submitted:
Month
Day Year
4 of 5
OMB Control No. 0970-0449
OMB Control No. 0970-0449
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
Expiration Date: 03/31/21
LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020
LIHEAP Performance Measures
Expiration Date: 03/31/21
Module III. (Optional LIHEAP Performance Measures)
V. ENERGY BURDEN TARGETING (OPTIONAL MEASURES)
A. All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)
1. Average Annual Electricity Usage
2. Average Annual Main Heating Usage
B. High Burden Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)
1. Average Annual Electricity Usage for High Burden
2. Main Heating Usage for High Burden
C. Unduplicated Number of LIHEAP Bill Payment-Assisted Households that Use:
1.
2.
3.
4.
5.
Electricity as Supplemental Heating Fuel
Wood as Supplemental Heating Fuel
Other Supplemental Heating Fuel
Central Air Conditioning
Window/Wall A/C (including evaporative cooler)
Bill Payment-Assisted Household Main Fuel
All Households
Auto-Calculated
Auto-Calculated
Electricity
0
0
Natural Gas
0
0
Fuel Oil
0
0
Propane
0
0
Other Fuels
0
Auto-Calculated
Auto-Calculated
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Propane
0
Other Fuels
0
Propane
0
Other Fuels
0
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
Auto-Calculated
VI. RESTORATION OF HOME ENERGY SERVICE (OPTIONAL MEASURES)
Energy Source
A. Number of All LIHEAP-Assisted Households that Had:
Unduplicated Count of Restorations of Home Energy Service
All Households
Auto-Calculated
Electricity
0
Natural Gas
0
Fuel Oil
0
VII. PREVENTION OF LOSS OF HOME ENERGY SERVICE (OPTIONAL MEASURES)
Energy Source
A. Number of All LIHEAP-Assisted Households that Had:
Unduplicated Count of Preventions of Loss of Home Energy Service
All Households
Auto-Calculated
Electricity
0
Natural Gas
0
Fuel Oil
0
VIII. CERTIFICATION FOR OPTIONAL DATA
1A. I certify to the best of my knowledge and belief that this report is correct and complete for Administration and Congressional oversight the program and for the purposes set forth in the award letter.
2A. Typed or Printed Name and Title of Authorized Certifying Official:
3A. Signature of Authorized Certifying Official: (click to sign)
[ADMIN_LIHEAP_CARESActRevisedLPDF_FY2020.xlsx]LIHEAP PM OPTIONAL Measures!
Date Submitted:
Month
Day Year
5 of 5
| File Type | application/pdf |
| Author | ACF;Verve |
| File Modified | 2020-12-03 |
| File Created | 2020-12-03 |