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Section 2 - HEATING ASSISTANCE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES August 1987, revised 05/92, 02/95, 03/96, 12/98, 11/01 OMB Clearance No.: 0970-013 Expiration Date: 02/28/2027

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN

Section 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 All Household Sizes 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 living in subsidized housing, the amount of the utility allowance is deducted from the total energy cost. Households receiving a utility allowance greater than the utility bill are not eligible. Applicants over 60 years old are exempt from this requirement. Renters with utilities included in the rent?

Yes No If yes, describe: Renters with utilities in rent must have a landlord agreement filled out that states that the landlord will pass on the benefit as a reduction in rent. Do you give priority in eligibility to: Older Adults (60 years or older)?

Yes No If yes, describe: Per Section 3.3, A.3. of the Louisiana LIHEAP Service Delivery Guide, Intake procedures must allow for special considerations for LIHEAP priority groups (i.e. elderly and/or disabled). Applications for the elderly (60 and above), and those with disabilities, must be given special consideration at least weekly in the form of a specific time and/or day to apply. Individuals with a disability?

Yes No If yes, describe: Per Section 3.3, A.3. of the Louisiana LIHEAP Service Delivery Guide, Intake procedures must allow for special considerations for LIHEAP priority groups (i.e. elderly and/or disabled). Applications for the elderly (60 and above), and those with disabilities, must be given special consideration at least weekly in the form of a specific time and/or day to apply. Young children?

Yes No If yes, describe: Households with high energy burdens?

Yes No If yes, describe: Other?

Yes No If yes, describe: Explanations of policies for each "yes" checked above:

Determination of Benefits 2605(b)(5) - Assurance 5, 2605(c)(1)(B) Page 9 of 55