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 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: Households with individuals 60 years and older will be prioritized for an appointment and additional provisions will be made as follows: Elderly and disabled clients should be seen in person once a year. Subsequent request for assistance, application should be via phone interview. Any changes in income can be verified by email, mail, uploading into CWP or delivered to the office. For subsequent request only “Signature on File” can be written by caseworker in place of actual client signature. 1. Subgrantees can send appointment notices to elderly and/or disabled clients in December to be seen in January because new Social Security and SSI income letters will have been received. Should further assistance be needed during the year, the client must submit a new application and provide the required documentation. Subgrantees should allocate the full amount of the bill including applicable fees (past due, transfer, etc.). 2. Individuals with a disability? Yes No If yes, describe: Households with an individual with a disability will be prioritized for an appointment and additional provisions will be made as follows: Elderly and disabled clients should be seen in person once a year. Subsequent request for assistance, application should be via phone interview. Any changes in income can be verified by email, mail, uploading into CWP or delivered to the office. For subsequent request only “Signature on File” can be written by caseworker in place of actual client signature. 1. Subgrantees can send appointment notices to elderly and/or disabled clients in December to be seen in January because new Social Security and SSI income letters will have been received. Should further assistance be needed during the year, the client must submit a new application and provide the required documentation. Subgrantees should allocate the full amount of the bill including applicable fees (past due, transfer, etc.). 2. Young children? Yes No If yes, describe: Households with children 5 years of age and under will be prioritized for an appointment. Households with high energy burdens? Yes No If yes, describe: Households with an high energy burden will be prioritized for an appointment. Other? Yes No If yes, describe: Explanations of policies for each "yes" checked above: See Eligibility and Benefit Determination Attachment. The applicant should provide either a copy of their lease; a notarized statement from the landlord detailing the heating/cooling arrangement with the client; or contract with the landlord that verifies the heating/cooling arrangement that the landlord has with the household. Persons/ households residing in public/subsidized housing dwellings unless their rent/mortgage includes utilities and they are not being billed separately for energy cost. 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. Recertification for vulnerable households (elderly and disabled) will be done during the first month of the program year. 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: See the LIHEAP Benefit Matrix Attachment: The benefit matrix has maximum amounts. The amounts of the client’s bills can be paid up to the maximum amount. We do not place a minimum on the benefit matrix because the amount of the bill is paid. 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 $1 Maximum Benefit $1,500 2.7 Do you provide in-kind (e.g., blankets, space heaters) and/or other forms of benefits?2 Yes No If yes, describe. Blankets, coats, heating systems repair or replacement, furnaces, space heaters, hot water tanks, may be provided during the winter. Additional energy related materials/services (such as home meter bases, utility poles/gas line hook-ups/repairs, energy kits/incentives) may be provided depending on need and State Office approval. 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.