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 State Median Income 60.00% 9 9 State Median Income 60.00% 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: Renters with utilities included in the rent? Yes No If yes, describe: Do you give priority in eligibility to: Older Adults (60 years or older)? Yes No If yes, describe: Priority in eligibility to elderly, disabled, or young children. An additional benefit is provided if at least one member of the household is elderly, disabled, or a child aged five or under. Individuals with a disability? Yes No If yes, describe: Priority in eligibility to elderly, disabled, or young children. An additional benefit is provided if at least one member of the household is elderly, disabled, or a child aged five or under. Young children? Yes No If yes, describe: Priority in eligibility to elderly, disabled, or young children. An additional benefit is provided if at least one member of the household is elderly, disabled, or a child aged five or under. Households with high energy burdens? Yes No If yes, describe: Priority in eligibility to elderly, disabled, or young children. An additional benefit is provided if at least one member of the household is elderly, disabled, or a child aged five or under. Other? Yes No If yes, describe: Explanations of policies for each "yes" checked above: Priority in eligibility to elderly, disabled, or young children. An additional benefit is provided if at least one member of the household is elderly, disabled, or a child aged five or under. 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. Vulnerable populations are provided an additional benefit when applying for heating assistance (see attached benefit payments matrix): •Applicant with one or more elderly members: Additional $100 benefit per household. •Applicant with one or more disabled members: Additional $100 benefit per household. •Applicant with one or more young children aged 5 or younger: Additional $150 benefit per household. 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: Applicant households with one or more vulnerable population members (elderly, disabled, or young children) are provided an additional benefit (see 2.4 above and attached). 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 $400 Maximum Benefit $1,350 2.7 Do you provide in-kind (e.g., blankets, space heaters) and/or other forms of benefits?2 Yes No If yes, describe. 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.