THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)Use of this model plan is optional. However, the information requested is required in order to receive a Low Income Home Energy Assistance Program (LIHEAP) grant.Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Section 1 Program Components Program Components, 2605(a), 2605(b)(1) - Assurance 1, 2605(c)(1)(C) 1.1 Check which components you will operate under the LIHEAP program. (Note: You must provide information for each component designated here as requested elsewhere in this plan.) Dates of Operation Start Date End Date Heating assistance 10/01/2025 09/30/2026 Cooling assistance Summer crisis assistance Winter crisis assistance Year-round crisis assistance 10/01/2025 09/30/2026 Weatherization assistance 10/01/2025 09/30/2026 Provide further explanation for the dates of operation, if necessary Estimated Funding Allocation, 2604(C), 2605(k)(1), 2605(b)(9), 2605(b)(16) - Assurances 9 and 16 1.2 Estimate what amount of available LIHEAP funds will be used for each component that you will operate: The total of all percentages must add up to 100%. Percentage ( % ) Prior year totals Heating assistance 65.00% 52.00% Cooling assistance 0.00% 0.00% Summer crisis assistance 0.00% 8.00% Winter crisis assistance 0.00% 0.00% Year-round crisis assistance 9.00% 0.00% Weatherization assistance 15.00% 25.00% Carryover to the following federal fiscal year 0.00% 0.00% Administrative and planning costs 10.00% 10.00% Services to reduce home energy needs including needs assessment (Assurance 16) 1.00% 5.00% Used to develop and implement leveraging activities 0.00% 0.00% TOTAL 100.00% 100.00% Tribal grant recipients: direct-grant tribes, tribal organizations, or territories with allotments of $20,000 or less may use for planning and administration up to 20% of the funds payable. Grant recipients that are direct grant tribes, tribal organizations, or territories with allotments over $20,000 may use for 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. SNAP Categorically Eligible Households: Households applying for LIHEAP who: 1. Are currently eligible for or receiving SNAP benefits. 2. Received or were approved to receive SNAP benefits during the month of the LIHEAP application. AND 3. When all members of the LIHEAP household are SNAP eligible, even if there are additional members in the SNAP household, they will be determined to be SNAP categorically eligible for LIHEAP benefits. LIHEAP/SNAP Categorically Eligible households applying for LIHEAP must: 1. Be currently eligible for SNAP benefits. 2. Received or were approved to receive SNAP benefits during the month of the LIHEAP application. 3. Each household member must be SNAP eligible. SSI, and/or TANF Households: SSI, and/or TANF benefit amount(s) of a household will be used to determine the amount of the LIHEAP benefit. Income documentation of SSI, and/or TANF benefit showing eligibility prior to the month in which the LIHEAP application is submitted, must be in the client file CHIMES/Perceptive bank statement, SSI letter, etc.). 1.5 Do you automatically enroll households without a direct annual application? Yes No If Yes, explain: Households determined eligible for the Subsidized Housing Energy Assistance modified LIHEAP benefit whose economic and housing situation does not change would be determined LIHEAP eligible for a period of five (5) years. 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? Income, household size, type of home, type of fuel and geographic location are the factors used to determine the benefit level. It is inconsequential whether they are categorically eligible or not. If the categorically eligible household's income exceeds the program income limit, the household will still receive a benefit using the lowest multiplying factor. 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: $25.00 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? Residents of subsidized housing whose energy costs are included as a portion of their rent or who reside in subsidized housing and have an obligation to pay a base load electric bill are not eligible for a regular LIHEAP benefit as determined in ARM 37.70.601. However, these households are eligible for a modified LIHEAP benefit. The modified LIHEAP benefit is paid at the rate of 5% of the amount of the regular LIHEAP benefit as identified by Montana's LIHEAP benefit award matrix. A minimum payment of $25 will be paid to the household annually. Basing payments to these households on the matrix will ensure that assistance is provided to them in proportion to need in accordance with LIHEAP statute (42 U.S. Code 8623) Applications and Requirements Section 2605 (b)(5). In order to document the subsidized household has an energy burden the agency will document either: The amount of rent the household pays; or 1. Proof the electric bill is in the client's name. 2. Households determined eligible for the Subsidized Housing Energy Assistance modified LIHEAP benefit whose economic and housing situation does not change will be determined LIHEAP eligible for a period of five (5) years. The LIHEAP application cover letter and the LIHEAP application contain statements informing the client to reapply when they move or their circumstances change to continue LIHEAP eligibility. In addition, the Office of Public Assistance (SNAP Office) notifies clients of the requirement to reapply when circumstances change or they move to a new dwelling. Residents of subsidized housing whose economic or housing situation changes during the five (5) year eligibility period will need to reapply. The households do not need to wait five (5) years before reapplying. 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 Unemployment insurance Strike Pay Social Security Administration (SSA ) benefits Including MediCare deduction Excluding MediCare deduction Supplemental Security Income (SSI ) Retirement / pension benefits General Assistance benefits Temporary Assistance for Needy Families (TANF) benefits Loans that need to be repaid Cash gifts Savings account balance One-time lump-sum payments, such as rebates/credits, winnings from lotteries, refund deposits, etc. Jury duty compensation Rental income Income from employment through Workforce Investment Act (WIA) Income from work study programs Alimony Child support Interest, dividends, or royalties Commissions Legal settlements Insurance payments made directly to the insured Insurance payments made specifically for the repayment of a bill, debt, or estimate Veterans Administration (VA) benefits Earned income of a child under the age of 18 Balance of retirement, pension, or annuity accounts where funds cannot be withdrawn without a penalty. Income tax refunds Stipends from senior companion programs, such as VISTA Funds received by household for the care of a foster child Ameri-Corp Program payments for living allowances, earnings, and in-kind aid Reimbursements (for mileage, gas, lodging, meals, etc.) Other 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. 1.10 Do you have an online application process Yes No 1.10a If yes, describe the type of online application (Select all boxes that apply) A PDF version of the application is available online and can be downloaded, filled out and mailed in for processing. A state-wide online application that allows a customer to complete data entry and submit an application electronically for processing. One or more locally available online applications that allows a customer to complete data entry and submit an application electronically for processing. Online application that is also mobile friendly Other, please describe Please include a link(s) to a statewide application, if available: Montana DPHHS - SNAP, TANF, LIHEAP and Health Coverage Assistance Application (mt.gov) 1.10b Can all program components be applied for online? Yes No If no, explain which components can and cannot be applied for online. 1.11 Do you have a process for conducting and completing applications by phone Yes No 1.12 Do you or any of your subrecipients require in person appointments in order to apply Yes No If yes, please provide more information regarding why in-person appointments are required and in what circumstances they are required. 1.13 How can applicants submit documentation for verification? Select all that apply: In-person Mail Email Portal application Other, please describe FAX Hidden for Section 1