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APPENDIX M Effective: April 1, 2026 APPOINTMENT DATE This is the date of the client's appointment. If a client submits an application via email, mail, or dropbox, this will be the date the application is received. DATE STAMP THESE WITH THE RECEIVED DATE. CLIENT NAME Enter the First and Last Name of the applicant. NAME OF UTILITY VENDOR Enter the name of the utility vendor you are using the worksheet to determine their monthly Total Energy Cost (TEC). TYPE OF UTILITY (Circle One) Circle the type of utility. PREVIOUS BILL DATE Enter the date from the client's prior purchase shown on the client's utility documentation. This will be the date they previously received the utility type. PREVIOUIS PURCHASE AMOUNT Enter the amount paid, including all other energy related charges, for the purchase before the current purchase of the indicated utility type. CURRENT BILL DATE Enter the most recent bill date shown on the client's utility documentation for the current purchase. CURRENT PURCHASE AMOUNT Enter the amount paid or to be paid by the most recent bill date, including all other energy related charges. NOTE: PURCHASE AMOUNT SHOULD INCLUDE THE FOLLOWING ENERGY RELATED CHARGES: * Amount to purchase the utility type * Environmental Fees (Ex. Hazmat Fees, etc.) * Leak and/or Line Test Fees * Taxes The rest of the fields in the form are calculated, and do not require Subgrantee input. 30-DAY USAGE AMOUNT (TEC): Use this amount in the TEC field in the LIHEAP Cloud to determine the Heating or Cooling Benefit. NUMBER OF DAYS OF ENERGY REMAINING AT THE TIME OF APPOINTMENT: If this amount is 7 days or less, the client may be qualified for a Crisis Benefit once every 12 months. Use the written amount provided by the Utility Vendor to provide 30-days of the utility as your Crisis Benefit. If a written amount does not exist, use the 30-DAY USAGE AMOUNT (TEC). Prepaid Utility Calculation Worksheet Instructions