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APPENDIX H Effective: April 1, 2026

Income Determination Worksheet

In the event the LIHEAP Energy Software (LES) system is down, the Income Determination Worksheet may be used to determine the monthly income for completing paper applications, until they can be entered into the LES for processing.

Part 1. Establish Earned Income. Enter verified income from the last 30 days for all employed household members 18 years of age or older on the table below. Enter on Line 1. Check Stub Pay Period Ending Date or Check Date Gross Pay 1. 2. 3. 4. Total 1.$

Part 2. Obtain Average Earned Income.

Part 3. Conversion to Gross Monthly Income

Based on how often the applicant is paid, perform the appropriate calculation to obtain gross monthly income. Frequency of Pay Conversion Factor Weekly Multiply Line 2 by 4.333 Biweekly (every other week) Multiply Line 2 by 2.167 Twice a month Multiply Line 2 by 2 Annually Divide annual income by 12 Enter result of conversation on Line 3. 3.$

Part 4. Establish Unearned Income. List each type and amount of unearned income in the table below. Enter total on Line 4. Note: If unearned income is not received on a monthly basis, use the appropriate conversion factor (see tab le above) to convert the amount to monthly.

Type of Unearned Income Gross Monthly Amount Total 4.$

Part 5. Gross Monthly Income.

Part 6. Determining Eligibility. Use the figure on Line 5, along with family size, to determine an applicant's income eligibility, using the 60% of State Median Income.

.$