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planning and administration purposes up to 20% of the first $20,000 (or $4,000) plus 10% of the funds payable that exceeds $20,000. Any administrative costs in excess of these limits must be paid from non-federal sources.

Alternate Use of Crisis Assistance Funds, 2605(c)(1)(C) 1.3 The funds reserved for winter crisis assistance that have not been expended by March 15 will be reprogrammed to:

Heating assistance

Cooling assistance

Weatherization assistance

Other (specify:)

Categorical Eligibility, 2605(b)(2)(A) - Assurance 2, 2605(c)(1)(A), 2605(b)(8A) - Assurance 8 1.4 Do you consider households categorically eligible if at least one household member receives at least one of the following categories of benefits in the left column below? Yes No If you answered "Yes" to question 1.4, you must complete the table below and answer questions 1.5 and 1.6.

Heating Cooling Crisis Weatherization TANF

Yes No

Yes No

Yes No

Yes No SSI

Yes No

Yes No

Yes No

Yes No SNAP

Yes No

Yes No

Yes No

Yes No Means-tested Veterans Programs

Yes No

Yes No

Yes No

Yes No 1.4a. Provide your definition of categorical eligibility. Please explain how households are categorically eligible (i.e, do all household members need to receive the benefits or just one member, is there a data exchange in place?) and how categorical eligibility streamlines the LIHEAP application process.

1.5 Do you automatically enroll households without a direct annual application? Yes No If Yes, explain:

1.6 How do you ensure there is no difference in the treatment of categorically eligible households from those not receiving other public assistance when determining eligibility and benefit amounts?

SNAP Nominal Payments 1.7a Do you allocate LIHEAP funds toward a nominal payment for SNAP households? Yes No If you answered "Yes" to question 1.7a, you must provide a response to questions 1.7b, 1.7c, and 1.7d. 1.7b Amount of Nominal Assistance: $0.00 1.7c Frequency of Assistance

Once Per Year

Once every five years

Other - Describe: 1.7d How do you confirm that the household receiving a nominal payment has an energy cost or need?

Determination of Eligibility - Countable Income

1.8. In determining a household's income eligibility for LIHEAP, do you use gross income or net income?

Gross Income

Net Income

Other - Describe 1.9. Select all the applicable forms of countable income used to determine a household's income eligibility for LIHEAP

Wages

Self - Employment Income

Contract Income

Payments from mortgage or Sales Contracts Page 5 of 55