Form FY23 LIHWAP Quarterly Report FY23

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Overview

Quarterly Q1
Quarterly Q2
Quarterly Q3
Quarterly Q4

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Sheet 1: Quarterly Q1

OMB Control No. 0970-0578		Expiration Date: XXXXXX
Low Income Household Water Assistance Program Quarterly Performance and Management Form
Recipient Information
Recipient Name:
Contact Name:
Contact Phone Number:
Contact Email:
First Quarterly Performance and Management Report (October 1- December 31)
I. Total Households Assisted
	A. Total Households Q1
1. Unduplicated number of households assisted
II. Assistance Provided by Service Type
	Number of assisted households by Service Type
Type of LIHWAP assistance for households	A. Water or Wastewater	B. Multiple Water Services	C. Other Water Services
1. Restoration of services	0	0	0
2. Prevention of disconnection of services	0	0	0
3. Reduction of rates charged	0	0	0
*If other services were paid for with LIHWAP funds, please explain
Response:
III. Performance Management
Describe up to three notable accomplishments achieved by LIHWAP during the implementation period, including any innovative approaches or policies that were put into place during the reporting period. Please include a participant success story, if applicable.
Response:
2. Describe any challenges with LIHWAP implementation during the reporting period.
Response:
3. Are there additional unmet water or wastewater needs in your service area? If yes, please describe.
Response:
4. Do you have any training and/or technical assistance needs that you would like the Office of Community Services to offer support for?
Response:
IV. Use of Funds
	Actual Obligated Funds
	A. Consolidated Appropriation Act, 2021 Funding	B. American Rescue Act, 2021 Funding	C. Reserve for Possible Future
1. Funding obligated to date for the Fiscal Year
V. Remarks
1. Enter any explanation needed regarding the reliability and/or validity of the above-reported data.
Response:
VI. Certification
Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)
a. Name of Authorized Official:
b. Title of Authorized Official:
c. Signature of Authorized Official:
d. Date Signed:

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Sheet 2: Quarterly Q2

OMB Control No. 0970-0578		Expiration Date: XXXXXX
Low Income Household Water Assistance Program Quarterly Performance and Management Form
Recipient Information
Recipient Name:
Contact Name:
Contact Phone Number:
Contact Email:
Second Quarterly Performance and Management Report (January 1- March 31)
I. Total Households Assisted
	A. Total Households Q2	B Total Cumulative Households
1. Unduplicated number of households assisted		0
II. Assistance Provided by Service Type
	Number of assisted households by Service Type
Type of LIHWAP assistance for households	A. Water or Wastewater	B. Multiple Water Services	C. Other Water Services
1. Restoration of services	0	0	0
2. Prevention of disconnection of services	0	0	0
3. Reduction of rates charged	0	0	0
*If other services were paid with LIHWAP funds, please explain
Response:
III. Performance Management
1. Describe up to three notable accomplishments achieved by LIHWAP during the implementation period, including any innovative approaches or policies that were put into place during the reporting period. Please include a participant success story, if applicable.
Response:
2. Describe any challenges with LIHWAP implementation during the reporting period.
Response:
3. Are there additional unmet water and wastewater needs in your service area? If yes, please describe.
Response:
4. Do you have any training and/or technical assistance needs that you would like the Office of Community Services to offer support for?
Response:
IV. Use of Funds
	Actual Obligated Funds
	A. Consolidated Appropriation Act, 2021 Funding	B. American Rescue Act, 2021 Funding	C. Reserve for Possible Future
1. Funding obligated to date for the Fiscal Year
V. Remarks
1. Enter any explanation needed regarding the reliability and/or validity of the above-reported data.
Response:
VI. Certification
Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)
a. Name of Authorized Official:
b. Title of Authorized Official:
c. Signature of Authorized Official:
d. Date Signed:

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Sheet 3: Quarterly Q3

OMB Control No. 0970-0578		Expiration Date: XXXXXX
Low Income Household Water Assistance Program Quarterly Performance and Management Form
Recipient Information
Recipient Name:
Contact Name:
Contact Phone Number:
Contact Email:
Third Quarterly Performance and Management Report (April 1 - June 30)
I. Total Households Assisted
	A. Total Households Q3	B. Total Cumulative Households
1. Unduplicated number of households assisted		0
II. Assistance Provided by Service Type
	Number of assisted households by Service Type
Type of LIHWAP assistance for households	A. Water or Wastewater	B. Multiple Water Services	C. Other Water Services
1. Restoration of services	0	0	0
2. Prevention of disconnection of services	0	0	0
3. Reduction of rates charged	0	0	0
*If other services were paid with LIHWAP funds, please explain
Response:
III. Performance Management
1. Describe up to three notable accomplishments achieved by LIHWAP during the implementation period, including any innovative approaches or policies that were put into place during the reporting period. Please include a participant success story, if applicable.
Response:
2. Describe any challenges with LIHWAP implementation during the reporting period.
Response:
3. Are there additional unmet water and wastewater needs in your service area? If yes, please describe.
Response:
4. Do you have any training and/or technical assistance needs that you would like the Office of Community Services to offer support for?
Response:
IV. Use of Funds
	Actual Obligated Funds
	A. Consolidated Appropriation Act, 2021 Funding	B. American Rescue Act, 2021 Funding	C. Reserve for Possible Future
1. Funding obligated to date for the Fiscal Year
V. Remarks
1. Enter any explanation needed regarding the reliability and/or validity of the above-reported data.
Response:
VI. Certification
Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)
a. Name of Authorized Official:
b. Title of Authorized Official:
c. Signature of Authorized Official:
d. Date Signed:

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Sheet 4: Quarterly Q4

OMB Control No. 0970-0578		Expiration Date: XXXXXX
Low Income Household Water Assistance Program Quarterly Performance and Management Form
Recipient Information
Recipient Name:
Contact Name:
Contact Phone Number:
Contact Email:
Fourth Quarterly Performance and Management Report (July 1 - September 30)
I. Total Households Assisted
	A. Total Households Q4	B. Total Cumulative Households
1. Unduplicated number of households assisted		0
II. Assistance Provided by Service Type
	Number of assisted households by Service Type
Type of LIHWAP assistance for households	A. Water or Wastewater	B. Multiple Water Services	C. Other Water Services
1. Restoration of services	0	0	0
2. Prevention of disconnection of services	0	0	0
3. Reduction of rates charged	0	0	0
*If other services were paid with LIHWAP funds, please explain
Response:
III. Performance Management
1. Describe up to three notable accomplishments achieved by LIHWAP during the implementation period, including any innovative approaches or policies that were put into place during the reporting period. Please include a participant success story, if applicable.
Response:
2. Describe any challenges with LIHWAP implementation during the reporting period.
Response:
3. Are there additional unmet water and wastewater needs in your service area? If yes, please describe.
Response:
4. Do you have any training and/or technical assistance needs that you would like the Office of Community Services to offer support for?
Response:
5. Please list and describe up to three lessons learned during the first year of LIHWAP implementation.
Response:
IV. Use of Funds
	Actual Obligated Funds
	A. Consolidated Appropriation Act, 2021 Funding	B. American Rescue Act, 2021 Funding	C. Reserve for Possible Future
1. Funding obligated to date for the Fiscal Year
V. Remarks
1. Enter any explanation needed regarding the reliability and/or validity of the above-reported data.
Response:
VI. Certification
Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)
a. Name of Authorized Official:
b. Title of Authorized Official:
c. Signature of Authorized Official:
d. Date Signed: