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Eligibility, 2605(c)(1)(A), 2605(b)(2) - Assurance 2 5.1 Designate the income eligibility threshold used for the Weatherization component Add Household Size Eligibility Guideline Eligibility Threshold 1 All Household Sizes HHS Poverty Guidelines 200.00% 5.2 Do you enter into an interagency agreement to have another government agency administer a WEATHERIZATION component? Yes No 5.3 If yes, name the agency and attach a copy of the Internal Agreement or Contract. 5.4 Is there a separate monitoring protocol for weatherization? Yes No WEATHERIZATION - Types of Rules 5.5 Under what rules do you administer LIHEAP weatherization? (Check only one.) Entirely under LIHEAP (not DOE) rules Entirely under DOE WAP (not LIHEAP) rules Mostly under LIHEAP rules with the following DOE WAP rule(s) where LIHEAP and WAP rules differ (Check all that apply): Income Threshold Weatherization of entire multi-family housing structure is permitted if at least 66% of units (50% in 2- & 4-unit buildings) are eligible units or will become eligible within 180 days Weatherize shelters temporarily housing primarily low income persons (excluding nursing homes, prisons, and similar institutional care facilities). Other - Describe: Mostly under DOE WAP rules, with the following LIHEAP rule(s) where LIHEAP and WAP rules differ (Check all that apply.) Income Threshold Weatherization not subject to DOE WAP maximum statewide average cost per dwelling unit. Weatherization measures are not subject to DOE Savings to Investment Ration (SIR ) standards. Other - Describe: Cleaning, tuning, evaluating, repairing, and replacing heating and cooling systems will be allowed outside of DOE rules in order to provide safe, adequately and efficiently conditioned living spaces to reflect LIHEAP’s focus on health and safety. Households previously weatherized within the last fifteen years may be weatherized again, if determination is made that initial weatherization was substandard. Eligibility, 2605(b)(5) - Assurance 5 5.6 Do you require an assets test? Yes No 5.7 Do you have additional/differing eligibility policies for : Renters Yes No Renters living in subsidized housing? Yes No Renters with utilities included in the rent? Yes No 5.8 Do you give priority in eligibility to: Older Adults? Yes No Individuals with a disability? Yes No Young Children? Yes No House holds with high energy burdens? Yes No Other? High energy users Yes No If you selected "Yes" for any of the options in questions 5.6, 5.7, or 5.8, you must provide further explanation of these policies in the text field below. 5.7 Additional Eligibility Policy: Landlord must sign to allow weatherization. 5.8 Priority: LIHEAP/WAP reflects DOE priorities for service if there is a waiting list. Benefit Levels 5.9 Do you have a maximum LIHEAP weatherization benefit/expenditure per household? Yes No 5.9a If yes, what is the maximum? $0 5.10 Do you use an Average Cost per Unit (ACPU). Yes No 5.10a If so, what is the ACPU amount? $8,547 Types of Assistance, 2605(c)(1), (B) & (D) 5.11 What LIHEAP weatherization measures do you provide ? (Check all categories that apply.) Weatherization needs assessments/audits Energy related roof repair Caulking and insulation Major appliance repairs Storm windows Major appliance replacement Furnace/heating system modifications/repairs Windows/sliding glass doors Furnace replacement Doors Cooling system modifications/repairs Water Heater Water conservation measures Cooling system replacement Roof top solar Community solar projects Compact florescent light bulbs Other - Describe: Health and Safety measures such as installing carbon monoxide and smoke detectors, minor plumbing, electrical, roof or flooring repairs, minor drainage, gutters and downspouts, and removal of unvented space heaters. Attic and floor sealing, LED light bulbs, duct sealing and general heat waste reduction are also provided. Weatherization uses Weatherization Readiness as a supplemental program to address the issues of homes which have been deferred for Weatherization. Weatherization Readiness enables additional repairs to be performed which are beyond the scope of Weatherization. It prevents the house from being deferred until necessary repairs are completed by some other funding source. Weatherization Readiness repairs with LIHEAP funds are limited to a maximum of $600 each. 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.