THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)Use of this model plan is optional. However, the information requested is required in order to receive a Low Income Home Energy Assistance Program (LIHEAP) grant.Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of 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. Section 1 Program Components Program Components, 2605(a), 2605(b)(1) - Assurance 1, 2605(c)(1)(C) 1.1 Check which components you will operate under the LIHEAP program. (Note: You must provide information for each component designated here as requested elsewhere in this plan.) Dates of Operation Start Date End Date Heating assistance 10/01/2025 09/30/2026 Cooling assistance 10/01/2025 09/30/2026 Summer crisis assistance Winter crisis assistance Year-round crisis assistance 10/01/2025 09/30/2026 Weatherization assistance 10/01/2025 09/30/2026 Provide further explanation for the dates of operation, if necessary Arizona has identified date ranges for heating and cooling and has assigned a date range to each county for FFY 2026. HEATING (November 1-March 31) and COOLING (April 1-October 31) for counties: Coconino, Yavapai, Navajo, Apache, Greenlee, Graham, Cochise, and Santa Cruz. HEATING (December 1-March 31) and COOLING (April 1-November 30) for counties: Mojave, La Paz, Yuma, Maricopa, Gila, Pinal, and Pima. The heating and cooling months overlap due to weather conditions. Since the LIHEAP adjudication and application processing portion of this program will be administered within DES through the utilization of an online portal, DES will be allocating monthly LIHEAP funds based on the heating and cooling needs of each location. DES will budget in this manner in order to keep the LIHEAP program operating throughout the entire year. The heating and cooling months illustrate when heating and cooling begins for each Arizona region. The above dates are based on the calendar year. Funding for the Federal Fiscal Year is not affected by the heating and cooling months listed above. Estimated Funding Allocation, 2604(C), 2605(k)(1), 2605(b)(9), 2605(b)(16) - Assurances 9 and 16 1.2 Estimate what amount of available LIHEAP funds will be used for each component that you will operate: The total of all percentages must add up to 100%. Percentage ( % ) Prior year totals Heating assistance 16.80% 16.80% Cooling assistance 38.12% 38.12% Summer crisis assistance 0.00% 0.00% Winter crisis assistance 0.00% 0.00% Year-round crisis assistance 5.00% 5.00% Weatherization assistance 15.00% 15.00% Carryover to the following federal fiscal year 10.00% 10.00% Administrative and planning costs 10.00% 10.00% Services to reduce home energy needs including needs assessment (Assurance 16) 5.00% 5.00% Used to develop and implement leveraging activities 0.08% 0.08% TOTAL 100.00% 100.00% Tribal grant recipients: direct-grant tribes, tribal organizations, or territories with allotments of $20,000 or less may use for planning and administration up to 20% of the funds payable. Grant recipients that are direct grant tribes, tribal organizations, or territories with allotments over $20,000 may use for planning and administration purposes up to 20% of the first $20,000 (or $4,000) plus 10% of the funds payable that exceeds $20,000. Any administrative costs in excess of these limits must be paid from non-federal sources. Alternate Use of Crisis Assistance Funds, 2605(c)(1)(C) 1.3 The funds reserved for winter crisis assistance that have not been expended by March 15 will be reprogrammed to: Heating assistance Cooling assistance Weatherization assistance Other (specify:) Support a year-round crisis assistance program that includes heating and cooling. Categorical Eligibility, 2605(b)(2)(A) - Assurance 2, 2605(c)(1)(A), 2605(b)(8A) - Assurance 8 1.4 Do you consider households categorically eligible if at least one household member receives at least one of the following categories of benefits in the left column below? Yes No If you answered "Yes" to question 1.4, you must complete the table below and answer questions 1.5 and 1.6. Heating Cooling Crisis Weatherization TANF Yes No Yes No Yes No Yes No SSI Yes No Yes No Yes No Yes No SNAP Yes No Yes No Yes No Yes No Means-tested Veterans Programs Yes No Yes No Yes No Yes No 1.4a. Provide your definition of categorical eligibility. Please explain how households are categorically eligible (i.e, do all household members need to receive the benefits or just one member, is there a data exchange in place?) and how categorical eligibility streamlines the LIHEAP application process. Categorical Eligibility is a determination that a Household meets income eligibility for LIHEAP assistance based upon one (1) or more Household member’s active enrollment in either DES Cash Assistance (CA) under Temporary Assistance for Needy Families (TANF) or DES Nutrition Assistance (NA) under the Supplemental Nutrition Assistance Program (SNAP). 1.5 Do you automatically enroll households without a direct annual application? Yes No If Yes, explain: N/A 1.6 How do you ensure there is no difference in the treatment of categorically eligible households from those not receiving other public assistance when determining eligibility and benefit amounts? We ensure that we are treating households equally, regardless of whether they are receiving public assistance, because DES allows households to qualify based on categorical eligibility or based upon independent verification of household income. In both cases, the reported income of the household is used to determine benefit amounts per the LIHEAP Matrix. SNAP Nominal Payments 1.7a Do you allocate LIHEAP funds toward a nominal payment for SNAP households? Yes No If you answered "Yes" to question 1.7a, you must provide a response to questions 1.7b, 1.7c, and 1.7d. 1.7b Amount of Nominal Assistance: $0.00 1.7c Frequency of Assistance Once Per Year Once every five years Other - Describe: 1.7d How do you confirm that the household receiving a nominal payment has an energy cost or need? N/A Determination of Eligibility - Countable Income 1.8. In determining a household's income eligibility for LIHEAP, do you use gross income or net income? Gross Income Net Income Other - Describe 1.9. Select all the applicable forms of countable income used to determine a household's income eligibility for LIHEAP Wages Self - Employment Income Contract Income Payments from mortgage or Sales Contracts Unemployment insurance Strike Pay Social Security Administration (SSA ) benefits Including MediCare deduction Excluding MediCare deduction Supplemental Security Income (SSI ) Retirement / pension benefits General Assistance benefits Temporary Assistance for Needy Families (TANF) benefits Loans that need to be repaid Cash gifts Savings account balance One-time lump-sum payments, such as rebates/credits, winnings from lotteries, refund deposits, etc. Jury duty compensation Rental income Income from employment through Workforce Investment Act (WIA) Income from work study programs Alimony Child support Interest, dividends, or royalties Commissions Legal settlements Insurance payments made directly to the insured Insurance payments made specifically for the repayment of a bill, debt, or estimate Veterans Administration (VA) benefits Earned income of a child under the age of 18 Balance of retirement, pension, or annuity accounts where funds cannot be withdrawn without a penalty. Income tax refunds Stipends from senior companion programs, such as VISTA Funds received by household for the care of a foster child Ameri-Corp Program payments for living allowances, earnings, and in-kind aid Reimbursements (for mileage, gas, lodging, meals, etc.) Other Cash gifts over $50 are counted. Funds received by household for the care of an adopted child. 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. 1.10 Do you have an online application process Yes No 1.10a If yes, describe the type of online application (Select all boxes that apply) A PDF version of the application is available online and can be downloaded, filled out and mailed in for processing. A state-wide online application that allows a customer to complete data entry and submit an application electronically for processing. One or more locally available online applications that allows a customer to complete data entry and submit an application electronically for processing. Online application that is also mobile friendly Other, please describe N/A Please include a link(s) to a statewide application, if available: atozarizona.gov 1.10b Can all program components be applied for online? Yes No If no, explain which components can and cannot be applied for online. For Weatherization, a referral is sent from the online LIHEAP application to the Weatherization contractor, but another application is needed for additional eligibility review. For A16, services are provided by local CAAs and the applicant must contact them to receive those services. 1.11 Do you have a process for conducting and completing applications by phone Yes No 1.12 Do you or any of your subrecipients require in person appointments in order to apply Yes No If yes, please provide more information regarding why in-person appointments are required and in what circumstances they are required. N/A 1.13 How can applicants submit documentation for verification? Select all that apply: In-person Mail Email Portal application Other, please describe Fax. In person submissions are accepted by contracted Community Action Agencies for CAA clients receiving case management services. Hidden for Section 1