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APPENDIX O Effective: April 1, 2026 Date of Benefit(s), Service or Purchase Name of LIHEAP Eligible Client Served (If Applicable) Products Distributed to Client (If Applicable) Ex. energy kits Cost of Product(s) Energy Education Provided (Yes or No) Employee Hours to review client eligibility, distribute products and/or educate clients Employee Cost to review client eligibility, distribute products and/or educate clients Advertising Materials Purchased (Yes or No) Type of Advertisement material (ex.. Radio, TV, pamplets) Cost of Advertisement Employee Hours to prepare and distrubute advertisement material Employee Cost to prepare and distrubute advertisement material Client Education Equipment Purchased (Yes or No) Type of Equipment (ex. Computer, printer, scanner) Cost of Equipment Employee Hours to procure equipment and place orders Employee Cost to procure equipment and place orders Comments (Please include outcome of Client Education to Applicants) Assurance 16 Benefits for LIHEAP Eligible Households Tracking Form FY 20 ****This spreadsheet will be used to track total clients served, the amount of employee hours, the equipment purchased, and services rendered using Client Education funds. **** Copies of all invoices must be submitted to support all expenditures. Detailed timesheets must be submitted to document time charged to the program. This report is due annually by August 15th for the period covering August 1st – July 31st of the previous year.