Annual Performance and Management Report for LIHWAP

19

U.S. Department of Health and Human Services

Administration for Children and Families

Office of Community Services (OCS)

Instructions for Completion of Annual Report

for Low Income Household Water Assistance Program (LIHWAP)

The Paperwork Reduction Act of 1995

This information collection (OMB Control No. 0970-0578; Expiration Date: 04/30/2022) is conducted in accordance with the Low Income Household Water Assistance Program (LIHWAP) statute (Public Law 116-260). Information received from this collection provides data to the Administration and Congress in its oversight of recipients' performance in administering the LIHWAP program.

Public reporting burden for this information collection (LIHWAP Annual Report), is estimated to be an average burden of 211 hours per respondent. The estimates include the time for reviewing instructions, and gathering, editing, maintaining, and reporting the data.

The responses to this information collection are required in order to obtain LIHWAP data in accordance with the LIHWAP Terms and Conditions. This information collection is required of all recipients that are receiving LIHWAP funds.

This information is not considered confidential; therefore, no additional safeguards are considered necessary beyond that customarily applied to routine government information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

LIHWAP data is submitted through the LIHWAP Annual Report reporting form. The complete set of instructions for reporting the required data is available in the next section of this document.

OVERVIEW

The LIHWAP Annual Report is a tool for HHS to learn about the implementation of LIHWAP. The Annual Report is composed of three modules to provide information concerning LIHWAP use of funds, household report, and performance measures.

LIHWAP Laws and Regulations and the LIHWAP Terms and Conditions are available on the following web links:

LIHWAP Laws and Regulations

https://www.acf.hhs.gov/ocs/law-regulation/lihwap-laws-and-regulations

LIHWAP Terms and Conditions

https://www.acf.hhs.gov/sites/default/files/documents/ocs/Attachment%20A_LIHWAP%20Terms%20and%20Conditions_State%20Signature%20Block.pdf

On May 8, 2020, HHS notified recipients that 98.5 percent of the available LIHWAP funding will be released to recipients and published a Dear Colleague Letter (DCL) 2021-05 LIHWAP Funding Release. The DCL notified recipients that LIHWAP recipients must track, account for, and report on, the LIHWAP Consolidated Appropriations Act of 2021 separate from the American Rescue Plan Act of 2021 funding.

GENERAL INSTRUCTIONS

An Excel workbook entitled the LIHWAP Annual Report has been developed for states, territories, and tribes to report LIHWAP data for each reporting year. Recipients are required to submit their annual data submissions using the Excel workbook.

Reporting Period and Due Dates – The LIHWAP Annual Report will be due January 31st of the following year.

FY 2022: Implementation – September 30, 2022 (Report due January 31, 2023)

FY 2023: October 1, 2022 – September 30, 2023 (Report due January 31, 2024)

Household data are for the FY reporting period (e.g., October 1 – September 30). Recipients may operate their programs on a different program year (e.g., starting January 1 or July 1). However, complete household data still need to be reported for the FY reporting period.

Data Consistency - The data will be checked for consistency against the type of LIHWAP assistance that recipients report in their LIHWAP Model Plan for FY2022, and with the data reported in each recipient’s LIHWAP Quarterly Performance and Management Report.

Report Submission Details - Submit the completed LIHWAP Annual Report with a copy to your Program Specialist to:

LIHWAPreports@acf.hhs.gov

Key Definitions

Administrative Costs - Administrative costs are expenses by the recipient and its sub-recipient service providers for a portion of general administration and general organizational expenses, such as salaries and expenses of executive officers, personnel administration, accounting, grants management, and reporting. As specified in the LIHWAP Terms and Conditions, administrative costs may not exceed 15 percent of the total award.

Arrearage and rate reduction - For the purposes of LIHWAP, an arrearage refers to an unpaid past due bill for household drinking water and/or wastewater utility services while rate reduction refers to a full or partial payment of a currently due bill charged to a household for drinking water or wastewater services. Both payments may include payments of standard reconnection fees, charges, and penalties. However, these fees should be standard fees consistent with the existing and ongoing business practices of the water utility (rather than a special fee charged to LIHWAP households). Recipients have discretion in determining whether these costs are included in the maximum benefit level or are in addition to the maximum benefit level.

Assisted Household – Households that has been approved and received LIHWAP assistance.

Calculating and Assigning Households to Poverty Percent Intervals – to calculate poverty percent interval obtain the most recent HHS Poverty Guidelines for the recipients state, tribe or territory and multiple by the percentage of poverty for each interval (under 75%, 75% - 100%, 101% to 125%, 126% to 150%, and over 150%). Households are assigned to poverty percentage levels by dividing the annual gross income by the most recent HHS Poverty Guideline amount for the household size. For example, a household has an annual gross income $13,780. According to the 2021 HHS Poverty Guidelines for recipient, $12,880 represents 100 percent of the Poverty Guidelines for a one-person household. Divide the household’s income of $13,780 by $12,880 and multiply by 100 = 106.98. Rounding off to the nearest whole percent = 107% of the 2021 HHS Poverty Guidelines. That household is classified as being within the interval of “101%-125% poverty”.

Expended Funds – Funds that a recipient has actually spent.

Gross Household Income Adjusted by Household Size - Gross household income, adjusted by household size, is to be used in calculating a household’s poverty level, regardless of whether net income is used to establish income eligibility for LIHWAP assistance. Gross income is the household's annual income before any deductions or adjustments, such as taxes or medical costs, are made to household income.

Household - The unit for LIHWAP counting is the household, not the head of household or persons in the households. LIHWAP defines the term "household" as “any individual or group of individuals who are living together as one economic unit for whom residential drinking water and/or wastewater services are customarily purchased in common or who make undesignated payments for those services in the form of rent.” Household members are those individuals who comprise the household unit.

Household Applicant – The individual who applied for LIHWAP.

Household Member - Household members represent those related and/or unrelated individuals who are living together as one economic unit for whom residential water services are customarily purchased in common or who make undesignated payments for residential water services.

Net Income – A household’s gross earnings minus mandatory withholdings and deductions, such as state and federal income tax and social security contributions.

Obligated Funds – Funds that a recipient has made a definite commitment/has a legal liability to pay for goods and services ordered or received.

Outreach and Intake/Eligibility Costs - Outreach and intake/eligibility costs are expenses by the recipient and its subrecipient service providers for staff time and expenses directly related to implementation of a LIHWAP outreach plan. Intake and eligibility costs include services necessary to determine eligibility and benefit determination activities.

Recipient – A Recipient is defined as the LIHWAP lead agency for a state, territory, or tribe. Recipient is

synonymous with grantee, a term used previously in OCS communications.

Subrecipient - A Subrecipient is an organization that receives a portion, or sub-award, of the LIHWAP grant funding (usually through a contract or grant) from the LIHWAP lead agency for a state, territory, or tribe. While the LIHWAP lead agency retains responsibility and accountability for all activities carried out under the grant award, the state, territory, or tribe may select sub-recipient organizations to serve as local administering agencies who are subject to all terms and conditions of the award.

Unduplicated Household Counts - Recipients are required to report “unduplicated counts” of LIHWAP assisted households for each type of LIHWAP assistance provided each year. Unduplicated counts means that households are only counted once for each specific data variable.

Waitlisted Household- Household that has applied for LIHWAP assistance but were unable to be assisted because of lack of funding, regardless of whether their application was processed.

*This report regularly refers to the three main types of LIHWAP assistance a household could receive and the three main types of services a household could receive. The definitions for these types are listed below:

The three main types of assistance a household could receive are:

1. Restoration of services – households that were disconnected that received assistance to have drinking water and/or wastewater services restored.

2. Prevention of disconnection of services – households that received assistance that prevented drinking and/ or wastewater services from being disconnected.

3. Reduction of rates charged – households that received assistance to reduce the rates charged to them on their water bill to help ensure affordable drinking water and/or wastewater services.

The three main types of services a household could receive are:

1. Water and/or Wastewater Services – assistance with only water and/or wastewater services. In these instances, water and wastewater services are itemized on the beneficiaries’ water bill. The majority of households should receive this service.

2. Multiple Water Services – assistance with both water/wastewater services and other water services. In these instances, due to the inability to obtain an itemized list of charges on the water bill, households receive assistance with their entire bill, which could include fees related to the regular cost of water services, in order to restore services or prevent the disconnection of services. This could include payment of standard reconnection fees, charges, and penalties related to water and wastewater systems, including stormwater. However, these fees should be standard fees consistent with the existing and ongoing business practices of the water utility (rather than a special fee charged to LIHWAP households).

3. Other Water Services – assistance with other water services as outlined in the recipient’s grantee implementation plan, which may include limited water delivery services, specialized wastewater disposal services, or an annual tax to the tribe for support services, such as a membership tax.

SECTION-BY-SECTION INSTRUCTIONS

Recipient Information – Include all of the information being requested (i.e., name, phone number, and email address) for the individual who is filling out the annual data report/the person who should be contacted if OCS has questions concerning the report.

Certification - This is where the official signing the LIHWAP Annual Report certifies that information provided is true, complete, and accurate to the best of their knowledge, and provides the official’s name, job title, and signature. The Report will be considered incomplete and not accepted unless this information is included. Recipients should submit their completed LIHWAP Annual Report to their LIHWAP program specialist by the due date outlined in these instructions.

Module 1: Use of Funds Report

All LIHWAP recipients are required to provide estimates of sources and uses of funds, including obligated and expended funding of the given fiscal year (FY) for each type of LIHWAP assistance provided. Estimated funding allocation percentages for each component were submitted on the recipient’s grant implementation plan. (1.4) Convert the percentages for each into dollar amounts, rounding to the nearest dollar.

Section I: Grant Award Amounts

This section requires the recipient to enter the funding amounts for each line below as submitted on the recipient implementation plan for the reporting period from both the Consolidated Appropriation Act, 2021, and the American Rescue Act, 2021. Please note that item 6 is automatically calculated based on the entered actual grant award and that we have reserved a column for possible future program funding (this column should be ignored unless otherwise indicated).

1. Actual Grant Award – FY 2021 Allocation of Low-Income Household Drinking Water and Wastewater Emergency Assistance Program (LIHWAP) Funds to States, Territories and Tribes.

2. Estimated Household Benefit – The converted dollar amount of household benefits, based on the allocation percentage included in section 1.4 of grant implementation plan.

3. Estimated Outreach/Eligibility – The converted dollar amount of outreach/eligibility allocation percentage included in section 1.4 of grant implementation plan.

4. Estimated Administration – Recipient - The converted dollar amount of administration for the grantee included in section 1.4 of grant implementation plan.

5. Estimated Administration – Subrecipient (if applicable) – The converted dollar amount of administration for subrecipient if applicable included in section 1.4 of grant implementation plan.

6. Actual Admin Cost Cap (15%) – 15% of Actual Grant Award allocation entered in response 1.

Section II: Uses of LIHWAP Household Benefit Funds

This section requires recipients to report the actual funds obligated and the actual funds expended for both the Consolidated Appropriation Act and the American Rescue Act in two different subsections. In Subsection A, recipients should report these funds by the type of LIHWAP assistance provided, and in subsection B, recipients should report the funds by the service type (definitions of “type of assistance” and “type of service” are included below). Amounts entered should be rounded to the nearest dollar.

2. Type of LIHWAP Assistance Funds by Priority (Items 1-3)

   1. Restoration of service funds – amount of funding obligated and expended to restore drinking and/or wastewater services to households that were disconnected.

   2. Prevention of Disconnection funds – amount of funding obligated and expended to prevent drinking and/ or wastewater services from being disconnected.

   3. Reduction of Rates Charged funds – amount of funding obligated and expended to reduce households’ water bill rates to help ensure affordable drinking water and/or wastewater services.

3. Type of LIHWAP Water and Wastewater Assistance Funds (Items 1-3)

   1. Water and/or Wastewater – amount of funding obligated and expended for households for only water/wastewater services that are itemized on the beneficiaries’ water bill. The majority of households should receive this service.

   2. Multiple Water Services – amount of funding that is obligated or expended for households for both water/wastewater services and other water services. In these instances, due to the inability to obtain an itemized list of charges on the water bill, households receive assistance with their entire bill, which could include fees related to the regular cost of water services, in order to restore services or prevent the disconnection of services. This could include payment of standard reconnection fees, charges, and penalties related to water and wastewater systems, including stormwater. However, these fees should be standard fees consistent with the existing and ongoing business practices of the water utility (rather than a special fee charged to LIHWAP households).

   3. Other Water Services – amount of funding that is obligated or expended for households that receive other water services as outlined in the recipient’s grantee implementation plan, which may include limited water delivery services, specialized wastewater disposal services, or an annual tax to the tribe for support services, such as a membership tax. Recipients providing assistance with “other water services” should include a list of these services under the section that states: Below please specify Other Water Services funded by LIHWAP.

Section III: Uses of LIHWAP Outreach/Eligibility Determination and Administration Funds

This section requires recipients to report their uses of LIHWAP Outreach/Eligibility Determination and Administration Funds for three categories of spending: 1) outreach/eligibility, 2) administration- recipient, 3) administration-subrecipient. For each category, enter the estimated funding allocations from the recipient plan, actual funding obligated, and the actual funding expended for both the Consolidated Appropriation Act 2021, and the American Rescue Act, 2021.

1. Outreach/Eligibility – amount of estimated funding allocation from section 1.4 of the recipients approved LIHWAP implementation plan and amounts of funding obligated and expended for outreach/eligibility.

2. Administration – Recipient – amount of estimated funding allocation from section 1.4 of recipients approved LIHWAP implementation plan and amounts of funding obligated and expended for grantee administration.

3. Administration – Subrecipients (if applicable) – amount of estimated funding allocation from section 1.4 of the recipients approved LIHWAP implementation plan and the amounts of funding obligated and expended for subrecipients administration.

Remarks – If the recipient needs to provide further explanation or clarification on the data provided in this section that could not be made in the fields on the report, they should provide these comments in the “Remarks” field at the bottom of the Module 1 table.

Module 2: LIHWAP Household Report

This section requires recipients to report on the number of LIHWAP households served by LIHWAP in total and by various data categories including by the type of assistance received, poverty level, vulnerable population status, and household demographic information (i.e., race, ethnicity, and gender). Instructions for each section and question are included below.

Section I: Number of Households

This question requires the recipient to report the total number of unduplicated household applicants, unduplicated households assisted, and total waitlisted households across all service areas, during the year. The total unduplicated household applicant count should include the total number of household applicants that applied for LIHWAP and received assistance and those were not approved to receive LIHWAP assistance.

An assisted household is one that applied for and received LIHWAP assistance. Households that have applied for a LIHWAP benefit but have not received one by the end of the year should be counted in the year that the household actually receives their benefit(s). Recipients are required to report unduplicated counts of the number of assisted LIHWAP households. An unduplicated count of assisted households means that households are to be counted only once regardless of the types of LIHWAP assistance received. For example, even if a household receives assistance with restoring their services and reducing the rate charged to them, for this particular question, the household would only be counted once.

For the total waitlisted households count, include the total number of households that applied for LIHWAP but were unable to be assisted because of lack of funding, regardless of whether their application was processed.

Section II: Number of Assisted Households by Assistance Type

This section requires recipients to report unduplicated counts of LIHWAP households by assistance type. Households that received multiple types of assistance should be included in the count of households for each relevant assistance type. For example, if the same household received assistance for restoration of services and reduction in the rates charged, it should be included in the count of households that received assistance for each service. See Table 1 below for an example of how to count unduplicated households by each type of LIHWAP assistance received. Recipients should report the following information:

4. Restoration of services –include the total unduplicated number of households that were disconnected that received assistance to have drinking water and/or wastewater services restored.

5. Prevention of disconnection of services – include the total unduplicated number of households that receive assistance that prevented drinking and/ or wastewater services from disconnection.

6. Reduction of current rate charges – include the total unduplicated number of households that received assistance to help ensure affordable household drinking water and/or wastewater services.

Table 1. Counting Unduplicated Numbered of Assisted Households for Each Type of LIWHAP Assistance

Household Scenarios	Restoration of Services	Prevention of Disconnection	Reducing Rates Charged
Household A receives restoration of services and reducing rates charged benefits.	1		1
Household B receives a prevention of disconnection benefit.		1
Household C applied for a restoration of services benefit but did not receive it.	0
Household D receives prevention of disconnection and reducing rates charged benefits.		1	1
Unduplicated Number of Households for each Type of LIHWAP Assistance	1	2	2

Section III: Number of Assisted Households by Poverty Level

Similar to Section II, Section III requires recipients to report unduplicated counts of LIHWAP households by assistance type and poverty level. For example, if a household between 75% - 100% of poverty receives both restoration of services and reduction of current rates charged, that households should be included in the count of households that received assistance for each service. Recipients should report the following information:

1. Restoration of services – include the total unduplicated number of households that were assisted with restoration of services by HHS Poverty Guidelines for Calendar Year.

2. Prevention of disconnection of services – include the total unduplicated number of households that were assisted with prevention of disconnection of services by HHS Poverty Guidelines for Calendar Year.

3. Reduction of current rate charges – include the total unduplicated number of households that were assisted with reducing rates charged by HHS Poverty Guidelines for Calendar Year.

The sum of the number of assisted households by each type of LIHWAP assistance across the poverty intervals must equal the total number of assisted households for each type of assistance listed in Section II. If this is not possible, provide the reason in the Remarks section at the end of the report.

Gross household income and household size also are needed for those households that are categorically eligible for LIHWAP assistance, such as households receiving Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), Supplementary Nutrition Assistance Program (SNAP), or certain needs-tested veterans’ benefits.

A household's gross annual income and/or household size can change during the fiscal year. If a household received two benefits or services under the same type of LIHWAP assistance, use that household's gross annual income and household size at the time of the initial determination of benefits or services in calculating that household's poverty level for statistical reporting.

Section IV – Number of Assisted Households by Vulnerable Population

Similar to the sections above, Section IV requires recipients to report unduplicated counts of LIHWAP households by assistance type and vulnerable household member status. Recipients should report the following information:

1. Restoration of services – include total number of households that were assisted with restoration of services by at least one household member was 60 years or older, disabled, had a child age 5 or under, and, the unduplicated count of households that had at least one vulnerable member.

2. Prevention of disconnection of services – include the total unduplicated number of households that were assisted with prevention of disconnection of services by at least one household member was 60 years or older, disabled, had a child age 5 or under, and, the unduplicated count of households that had at least one vulnerable member.

3. Reduction of current rate charges – include the total unduplicated number of households that were assisted with reducing rates charged by at least one household member was 60 years or older, disabled, had a child age 5 or under, and, the unduplicated count of households that had at least one vulnerable member.

4. Any type of LIHWAP assistance – the unduplicated count of households with at least one household member was 60 years or older, disabled, had a child age 5 or under, and, the unduplicated count of households that had at least one vulnerable member.

Data need to be reported separately for each of the three vulnerable groups of households for each type of LIHWAP assistance, as shown in Table 2. In calculating and reporting the data, note the following:

1. A household is to be counted for each vulnerable group in which the household has at least one member who is 60 years or older, disabled, or age 5 years or under. For example, a household that receives restoration of services assistance includes one 2-year old child, another 4-year old child, and an elderly member who also is disabled. This household would be counted once under each of the three vulnerable groups for restoration of services households: A.60 years or older, B. Disabled, or C. Age 5 years or under. The household would also be counted once under D. Elderly, disabled, or young child. This final count results in an unduplicated count of households with any individual member that is a vulnerable person i.e., elderly, young child, or disabled. Meaning one household may have multiple household members that fall under more than one vulnerable type. For example, a household might have one disabled, two children under 5. That household should only be counted one time in this category.

2. The data on vulnerable groups are household counts; not the count of vulnerable persons or the number of heads of households that are vulnerable. For example, a household with two members who are both 65 years old would be counted once under 60 years or older.

Household Scenarios

• Household A receives restoration of services. Household A has 4 members: Al-36, Cathy-29, Father-67 (ELD), Mother-72 (ELD) & (DIS)

• Household B receives restoration of services and reducing rates charged. Household B has 4 members: Alice-46, Tom-47, Jack-61 (ELD), and Fran-5 (YCH).

• Household C receives prevention of disconnection of services and reducing rates charged. Household C has 4 members: Andrew-42, Pauline-35, Charlie-6 (DIS), and Irene-72 (ELD).

• Household D receives prevention of disconnection of services. Household D has 4 members: Carl-27, Silvia-23, Ellen-4 (YCH), and Rick-6.

• Household E splits from Household D during the reporting year & receives reducing rates charged. Household E has 3 members: Silvia-23, Ellen-4 (YCH), and Rick-6.

Table 2. Household Scenarios in Counting Unduplicated Vulnerable Households by Type of LIHWAP Assistance

Type of LIHWAP Assistance	Elderly (ELD)	Disabled (DIS)	Young child (YCH)	Any (ELD, DIS, or YCH)
Restoration of services households	2 (A, B)	1 (A)	1 (B)	2 (A, B)
Prevention of disconnection of services households	1 (C)	1 (C)	1 (D)	2 (C, D)
Reducing rates charged households	2 (B, C)	1 (C)	2 (B, E)	3 (B, C, E)
Any type of LIHWAP assistance	3 (A, B, C)	2 (A, C)	3 (B, D, E)	5 (A, B, C, D, E)

*Do not add the separate numbers of elderly, disabled, or young child households to calculate the unduplicated number of Elderly, Disabled, or Young Child households for each Type of LIHWAP Assistance, as assisted households can have members counted under more than one vulnerable group.

Section V: Optional FY 22 Number of Assisted Household Applicants by Race and Ethnicity

This section requires recipients to report the race and ethnicity of assisted household applicants. Note: this section only asks about the race and ethnicity of the applicant and should not include race/ethnicity data on other household members. This section is optional for the Fiscal Year 2021 and 2022 reports but will be required for all recipients on the FY 23 Annual Report. This will allow recipients to make the needed changes to collect these data indicators. Recipients should report the following information:

1. Ethnicity:

1. Hispanic, Latino, or Spanish Origins – number of assisted household applicants that identify themselves as a part of this ethnic group.

2. Non-Hispanic, Latino or Spanish Origins – number of assisted household applicants that do not identify themselves as a part of this ethnic group.

3. Unknown/not reported – number of assisted household applicants that are unknown or not reported by ethnicity.

4. Total (Auto Calculated) - An unduplicated number of household applicants that identify themselves in any of these categories.

2. Race:

1. American Indian or Alaska Native – number of assisted household applicants that identify themselves as a part of this race.

2. Asian – number of assisted household applicants that identify themselves as a part of this race.

3. Black or African American – number of assisted household applicant that identify themselves as a part of this race.

4. Native Hawaiian or Other Pacific Islander – number of assisted household applicants that identify themselves as a part of this race.

5. White – number of assisted household applicants that identify themselves as a part of this race.

6. Multi-race (two or more of the above) – number of assisted household applicants that identify themselves as a part more than one race.

7. Other – number of assisted household applicants that identify themselves as a part of another.

8. Unknown/not reported – number of assisted household applicants that is unknown or was not reported.

9. Total (Auto Calculated) – An unduplicated number of household applicants that has identified themselves as a part of any of these races.

Section VI: Optional FY22 Number of Assisted Household Applicants by Gender

This section requires recipients to report gender of assisted household applicants. Note: this section only asks about the gender of the applicant and should not gender data on other household members. This section is optional for the Fiscal Year 2021 and 2022 reports but will be required for all recipients on the FY 23 Annual Report. This will allow recipients to make the needed changes to collect these data indicators. Recipients should report the following information:

1. Self-Identified Male – number of assisted household applicants that identify their gender as male.

2. Self-Identified Female – number of assisted household applicants that identify their gender as female.

3. Other – number of assisted household applicants that identify their gender as other.

4. Unknown/not reported – number of assisted household applicants that indicate gender is unknown or not reported.

5. Total (Auto Calculated) – an unduplicated number of household applicants that identify themselves in any of these gender categories.

Section VII: Optional FY22 Number of Assisted Households by Housing Type

This section requires recipients to report the housing type of all unduplicated assisted households. This section is optional for the Fiscal Year 2021 and 2022 reports but will be required for all recipients on the FY 23 Annual Report. This will allow recipients to make the needed changes to collect these data indicators. Recipients should report the following information:

Housing Type

1. Own

2. Rent with utilities billed separately

3. Rent with utilities in rental fee

3. Other

4. Unknown/not Reported

Section VIII: Optional FY22 Measure: Number of Assisted Household Members by Race and Ethnicity

This section requires recipients to report the race and ethnicity of all assisted household members. including the applicant. This section is optional for the Fiscal Year 2021 and 2022 reports but will be required for all recipients on the FY 23 Annual Report. This will allow recipients to make the needed changes to collect these data indicators. Recipients should report the following information:

1. Ethnicity:

1. Hispanic, Latino, or Spanish Origins – number of assisted household members that identify themselves as a part of this ethnic group.

2. Non-Hispanic, Latino or Spanish Origins – number of assisted household members that do not identify themselves as a part of this ethnic group.

3. Unknown/not reported – number of assisted household members that are unknown or not reported by ethnicity.

4. Total (Auto Calculated) - An unduplicated number of household members that identify themselves in any of these ethnic categories

2. Race:

1. American Indian or Alaska Native – number of assisted household members that identify themselves as a part of this race.

2. Asian – number of assisted household members that identify themselves as a part of this race.

3. Black or African American – number of assisted household members that identify themselves as a part of this race.

4. Native Hawaiian or Other Pacific Islander – number of assisted household members that identify themselves as a part of this race.

5. White – number of assisted household members that identify themselves as a part of this race.

6. Multi-race (two or more of the above) – number of assisted household members that identify themselves as a part more than one race.

7. Other – number of assisted household members that identify themselves as a part of another.

8. Unknown/not reported – number of assisted household members that is unknown or was not reported.

9. Total (Auto Calculated) - An unduplicated number of household members that has identified themselves as a part of any of these races.

Section IX: Optional FY 22 Measure: Number of Assisted Household Members by Gender

This section requires recipients to report the gender of all assisted household members. including the applicant. This section is optional for the Fiscal Year 2021 and 2022 reports but will be required for all recipients on the FY 23 Annual Report. This will allow recipients to make the needed changes to collect these data indicators. Recipients should report the following information:

1. Self-Identified Male – number of assisted household members that identify their gender as male.

2. Self-Identified Female – number of assisted household members that identify their gender as female.

3. Other – number of assisted household members that identify gender as other.

4. Unknown/not reported – number of assisted household members that indicate gender is unknown or not reported.

5. Total (Auto Calculated) – an unduplicated number of household members that identify themselves in any of these gender categories.

Section X: Use of Funds to Non-Public Water Systems for Emergency Home Water Service

Section IX is only applicable to recipients that were approved to use 'Non-Public Water Systems for Emergency Home Water Service' funds in their LIHWAP plan. If applicable, recipients should report the following information:

1. Private Water Delivery as Supplemental Drinking Water Services – number of assisted households that received supplemental drinking water services.

2. Private Waste Hauling as Supplemental Wastewater Services – number of assisted households that receive supplemental wastewater services.

3. Other Supplemental Water Services* – number of assisted households that received other supplemental water services specified by recipient.

*Recipients providing assistance with “other water services” should include a list of these services under the section that states: Below please specify Other Water Services funded by LIHWAP.

Remarks – If the recipient has concerns about the reliability or the validity of the data they provided in this report, they should provide an explanation of these concerns in the “Remarks” field at the bottom of the Module 2 table.

Module 3: Performance Measures Report

Each section in Module 3 is to be completed for assisted household data. Please note that Sections II-IV ask the recipient to provide both unduplicated counts and duplicated counts (if applicable) in reporting. Recipients should only provide a duplicated household count if the recipient has allowed a household to apply for and receive multiple payments of the same type of LIHWAP assistance as reported in section 2.6 of the LIHWAP implementation plan. For example, if a household was disconnected from water/wastewater services in November 2021, and received a restoration benefit and that same household was disconnected again in May 2022, and received another restoration benefit, the household should be counted once in the unduplicated count for restoration of home water/wastewater service and twice in the duplicated count for restoration of home water/wastewater service. Based on recipient implementation plans, OCS believes there will be a small number of recipients who will report a duplicated count that is different from the unduplicated count.

Section I: Water Burden Targeting

Water Burden is the proportion (amount) of total household income spent on drinking water and/or wastewater utility bills during a specific timeframe set by the recipient in its written policies (e.g., monthly, quarterly, or annually). This burden may be calculated based on gross income or net income depending upon the policies, procedures and requirements of the state, territory, or tribe. It is also calculated based on the amount billed to the household for such services. See the definitions section above for information on how to calculate gross and net income. Recipients should report the following information:

1. Average Water Benefit - The average water benefit payment for all households. Recipients should report the total count of households used to calculate the average water benefit, counting each household once for each type of assistance, restoration of services, prevention of disconnection or reduction of rate charged that was received.

2. Pre-Water Burden - The average household water burden average prior to receiving LIHWAP assistance. Recipients should report the total count of households used to calculate the average water benefit, counting each household once for each type of assistance, restoration of services, prevention of disconnection or reduction of rate charged that was received.

3. Post Water Burden - The average household water burden average after LIHWAP assistance is received. Report the post water burden average for households receiving restoration of services or prevention of disconnection of services if applicable. Recipients should report the total count of reduction of rate charged that was received.

Section II: Restoration of Home Water/Wastewater Service

Recipients should count all LIHWAP-assisted households with each with restoration of water/wastewater service (disconnected). For more information on assistance type and service types differences, please refer to the Key Definitions section above.

1. Restoration of Home Water/Wastewater Services (Unduplicated Count) – The total unduplicated counts of all assisted households that received restoration of services, by service type: water or wastewater, multiple water services, and other services. Recipients should report the total count of households, counting each household once if it received this type of assistance.

2. Restoration of Home Water/Wastewater Services (Duplicated Count, if applicable) – The total duplicated counts of all assisted households that were assisted with restoration of services, by service type: water or wastewater, multiple water services, and other services. Recipients should report the total count of households, counting each household for each type of assistance received.

Section III: Prevention of Loss of Home Water/Wastewater Service

Recipients should count all LIHWAP-assisted households with each prevention of loss of home water/wastewater service. For more information on assistance type and service types differences, please refer to the Key Definitions section above.

1. Prevention of Loss of Home Water/Wastewater Services (Unduplicated Count) – The total unduplicated counts of all assisted households that were assisted with prevention of disconnection of services, by service type: water or wastewater, multiple water services, and other services. Recipients should report the total count of households, counting each household once if it received this type of assistance.

2. Prevision of the Loss of Home Water/Wastewater Services (Duplicate Count, if applicable) – The total duplicated counts of all assisted households that were assisted with restoration of services, by service type: water or wastewater, multiple water services, and other services. Recipients should report the total count of households, counting each household for each type of assistance received.

Section IV: Rate Reduction of Current Home Water/Wastewater Service

Recipients should count all LIHWAP-assisted households with each rate reduction of current home water/wastewater service. For more information on assistance type and service type differences, please refer to the Key Definitions section above.

1. Rate Reduction of Current Home Water/Wastewater Services (Unduplicated) – The total unduplicated counts of all assisted households that were assisted with restoration of services, by service type: water or wastewater, multiple water services, and other services. Recipients should report the total count of households, counting each household once if it received this type of assistance.

2. Rate Reduction of Current Home Water/Wastewater Services (Duplicated, if applicable) – The total duplicated counts of all assisted households that were assisted with restoration of services, by service type: water or wastewater, multiple water services, and other services. Recipients should report the total count of households, counting each household for each type of assistance received.