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 1 State Median Income 60.00% 2 2 State Median Income 60.00% 3 3 State Median Income 60.00% 4 4 State Median Income 60.00% 5 5 State Median Income 60.00% 6 6 State Median Income 60.00% 7 7 State Median Income 60.00% 8 8 State Median Income 60.00% 9 9 State Median Income 60.00% 10 10 HHS Poverty Guidelines 150.00% 11 11 HHS Poverty Guidelines 150.00% 12 12 HHS Poverty Guidelines 150.00% 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 with utilities included in the rent? Yes No If yes, describe: Do you give priority in eligibility to: Older Adults (60 years or older)? Yes No If yes, describe: Subgrantees will make a good faith effort during the first ninety (90) days to serve Households who have a direct energy cost and who contain a Household member who is an Older Adult, Individual with a disability or a Household that contains a young (6 years of age or younger) child. Individuals with a disability? Yes No If yes, describe: Subgrantees will make a good faith effort during the first ninety (90) days to serve Households who have a direct energy cost and who contain a Household member who is an Older Adult, Individual with a disability or a Household that contains a young (6 years of age or younger) child. Young children? Yes No If yes, describe: Subgrantees will make a good faith effort during the first ninety (90) days to serve Households who have a direct energy cost and who contain a Household member who is an Older Adult, Individual with a disability or a Household that contains a young (6 years of age or younger) child. 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) 2.4 Describe how you prioritize the provision of heating assistance to vulnerable populations, e.g., benefit amounts, early application periods, etc. Intake/Application prioritization: Subgrantees will make a good faith effort during the first ninety (90) days to serve Households who have a direct energy cost and who contain a Household member who is an Older Adult, Individual with a disability or a Household that contains a young (6 years of age or younger) child. Benefit Amount: Households where a member is an Older Adult, Individual with a disability or have a young child will be awarded additional priority points during benefit determination. 2.5 Check the variables you use to determine your benefit levels. (Check all that apply): Income Family (household) size Home energy cost or need: Fuel type Climate/region Individual bill Dwelling type Energy burden (% of income spent on home energy) Energy need Other - Describe: Benefit Levels, 2605(b)(5) - Assurance 5, 2605(c)(1)(B) 2.6 Describe estimated benefit levels for the fiscal year for which this plan applies. Please note: the maximum and minimum benefits must be shown in the payment matrix. Minimum Benefit $88 Maximum Benefit $1,012 2.7 Do you provide in-kind (e.g., blankets, space heaters) and/or other forms of benefits?2 Yes No If yes, describe. Subgrantees provide a number of in-kind and/or other benefits including private contributions for fuel assistance. If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.