2 HEATING ASSISTANCE

Eligibility, 2605(b)(2) - Assurance 2 2.1 Designate the income eligibility threshold used for the heating component: Add Household size Eligibility Guideline Eligibility Threshold 1 1 State Median Income 60.00% 2 2 State Median Income 60.00% 3 3 State Median Income 60.00% 4 4 State Median Income 60.00% 5 5 State Median Income 60.00% 6 6 State Median Income 60.00% 7 7 State Median Income 60.00% 8 8 HHS Poverty Guidelines 150.00% 9 9 HHS Poverty Guidelines 150.00% 10 10 HHS Poverty Guidelines 150.00% 11 11 HHS Poverty Guidelines 150.00% 12 12 HHS Poverty Guidelines 150.00% 13 13 HHS Poverty Guidelines 150.00% 14 14 HHS Poverty Guidelines 150.00% 15 15 HHS Poverty Guidelines 150.00% 2.2 Do you have additional eligibility requirements for Heating Assistance? Yes No 2.3 Check the appropriate boxes below and describe the policies for each. Do you require an Assets test? Yes No If yes, describe: Do you have additional/differing eligibility policies for: Renters? Yes No If yes, describe: Renters Living in subsidized housing? Yes No If yes, describe: If a household in subsidized housing has utilities included in their rent and does not receive a utility bill, that household is not eligible for LIHEAP assistance, unless the household can demonstrate an energy burden. To be eligible for a LIHEAP benefit, a household in subsidized housing with utilities included in rent can demonstrate an energy burden by submitting a lease agreement or statement from the landlord reflecting utilities are included in the rent and also providing proof that the household is responsible for a utility surcharge or other extra cost for energy that exceeds the amount covered in the household’s rent. Renters with utilities included in the rent? Yes No If yes, describe: Unsubsidized households are those households that do not receive assistance as indicated above. Unsubsidized households with utilities included in their rent may be eligible for LIHEAP assistance if they meet other criteria. A member of the household must submit a lease agreement or statement from the landlord reflecting that utilities are included in the rent. A household can also demonstrate an energy burden by showing the household is responsible for a utility bill that exceeds the amount covered in the household’s rent. Do you give priority in eligibility to: Older Adults (60 years or older)? Yes No If yes, describe: Application intake for PRIORITY ENROLLMENT APPLICANTS who are seeking a Regular, Crisis, or both benefits will begin accepting applications no more than thirty (30) calendar days before other demographics unless otherwise authorized. Priority Enrollment applicants are applicants who are disabled, elderly (sixty or older), or households with children under six (6) years old. Once the standard LIHEAP season opens to the general public, applications will be processed on a first-come, first-served basis with an emphasis on applicants who have been disconnected, are in threat of disconnection, or are facing a life-threatening situation. Individuals with a disability? Yes No If yes, describe: Application intake for PRIORITY ENROLLMENT APPLICANTS who are seeking a Regular, Crisis, or both benefits will begin accepting applications no more than thirty (30) calendar days before other demographics unless otherwise authorized. Priority Enrollment applicants are applicants who are disabled, elderly (sixty or older), or households with children under six (6) years old. Once the standard LIHEAP season opens to the general public, applications will be processed on a first-come, first-served basis with an emphasis on applicants who have been disconnected, are in threat of disconnection, or are facing a life-threatening situation. Young children? Yes No If yes, describe: Application intake for PRIORITY ENROLLMENT APPLICANTS who are seeking a Regular, Crisis, or both benefits will begin no more than thirty (30) calendar days before all others unless otherwise authorized. Priority Enrollment applicants are applicants who are disabled, elderly (sixty or older), or households with children under six (6) years old. Once the standard LIHEAP season opens to the general public, applications will be processed on a first-come, first-served basis with an emphasis on applicants who have been disconnected, are in threat of disconnection, or are facing a life-threatening situation. Households with high energy burdens? Yes No If yes, describe: Other? Yes No If yes, describe: Explanations of policies for each "yes" checked above: Each applicant must provide proof of having an energy burden. The applicant has an energy burden if s/he pays utilities directly (receives a utility bill) or indirectly (utilities are included in rent). Households that receive utility subsidies (such as through reimbursement, allowance, or stipend) are not eligible for LIHEAP benefits unless the household can demonstrate an energy burden. Determination of Benefits 2605(b)(5) - Assurance 5, 2605(c)(1)(B) 2.4 Describe how you prioritize the provision of heating assistance to vulnerable populations, e.g., benefit amounts, early application periods, etc. Application intake for PRIORITY ENROLLMENT APPLICANTS who are seeking a Regular, Crisis, or both benefits will begin accepting applications no more than thirty (30) calendar days before other demographics unless otherwise authorized. Priority Enrollment applicants are applicants who are disabled, elderly (sixty or older), or households with children under six (6) years old. 2.5 Check the variables you use to determine your benefit levels. (Check all that apply): Income Family (household) size Home energy cost or need: Fuel type Climate/region Individual bill Dwelling type Energy burden (% of income spent on home energy) Energy need Other - Describe: Benefit Levels, 2605(b)(5) - Assurance 5, 2605(c)(1)(B) 2.6 Describe estimated benefit levels for the fiscal year for which this plan applies. Please note: the maximum and minimum benefits must be shown in the payment matrix. Minimum Benefit $60 Maximum Benefit $570 2.7 Do you provide in-kind (e.g., blankets, space heaters) and/or other forms of benefits?2 Yes No If yes, describe. The Weatherization Assistance Program (WAP) provides emergency weatherization services for households lacking heat or air conditioning. To provide these emergency services, WAP is authorized to bypass waiting lists and priority points. If a household has previously been weatherized and is not eligible for re-weatherization, WAP is authorized to use LIHEAP funds to address HVAC only. If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.