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APPENDIX M Effective: April 1, 2026 PREPAID UTILITY CALCULATION WORKSHEET APPOINTMENT DATE: CLIENT NAME NAME OF UTILITY VENDOR TYPE OF UTILITY (Circle One) ELECTRIC GAS PROPANE BUTANE Previous Bill Date: Previous Purchase Amount: Current Bill Date: Current Purchase Amount: Number of Days Passed Since Last Purchase 0 Daily Usage (Last Purchase Amt/ # of Days Since Last Purchase): #DIV/0! 30-Day Usage Amount (TEC): #DIV/0! (COOLING or HEATING Monthly Energy Usage Amount) CRISIS DETERMINATION Number of Days Available From Current Purchase Amount: #DIV/0! Number of Days Passed Since Most Recent Purchase 0 Number of Days of Energy Remaining at the Time of #DIV/0! Appointment NOTE: CLIENT MUST HAVE LESS THAN 7 DAYS OF ENERGY REMAINING AT THE TIME OF APPLICATION TO QUALIFY FOR CRISIS ASSISTANCE. Crisis Clients may present a written estimate from a propane vendor that includes the number of gallons needed to provide 30 days of propane and the estimated cost (i.e. CRISIS BENEFIT). If a written estimate does not exist, Subgrantees must use the 30-DAY USAGE AMOUNT (TEC) as the CRISIS BENEFIT.