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Eligibility - 2604(c), 2605(c)(1)(A) 4.1 Designate the income eligibility threshold used for the crisis component Add Household size Eligibility Guideline Eligibility Threshold 1 All Household Sizes State Median Income 60.00% 4.2 Provide your LIHEAP program's definition for determining a crisis. If you administer multiple crisis assistance programs (winter, summer, and/or year-round), Include all program definitions. See Section E of the ND State Plan Attachments document for details: Energy Crisis: This term means weather-related and supply shortage emergencies and other household energy-related emergencies 4.3 What constitutes a life-threatening crisis? See Section E of the ND State Plan Attachments document for details: Life-Threatening Energy Crisis: This term refers to an energy-related crisis that poses a serious threat to the health and safety of one or more members of the household. Crisis Requirement, 2604(c) 4.4 Within how many hours do you provide an intervention that will resolve the energy crisis for eligible households? 48Hours 4.5 Within how many hours do you provide an intervention that will resolve the energy crisis for eligible households in life-threatening situations? 18Hours Crisis Eligibility, 2605(c)(1)(A) Winter Crisis Summer Crisis Year-Round Crisis 4.6 Do you have additional eligibility requirements for Crisis Assistance? 4.7 Check the appropriate boxes below to indicate type(s) of assistance provided 0 Do you require an Assets test? Do you give priority in eligibility to: Older Adults (60 years or older)? Individuals with a disability? Young Children? Households with high energy burdens? Other (Specify): N/A In Order to receive crisis assistance: Must the household have received a shut-off notice or have a near empty tank? Must the household have been shut off or have an empty tank? Must the household have exhausted their regular heating benefit? Must renters with heating costs included in their rent have received an eviction notice? Must heating/cooling be medically necessary? Must the household have non-working heating or cooling equipment? Other (Specify): Any of the circumstances listed above. Do you have additional/differing eligibility policies for: Renters? Renters living in subsidized housing? Renters with utilities included in the rent? Explanations of policies for each "yes" checked above: Renters living in subsidized housing and are not subject to the rising costs of home energy and do not qualify for emergency assistance. However, North Dakota reserves the right to implement additional home energy benefits for these households as stated in policy. Determination of Benefits 4.8 How do you handle crisis situations? Separate component Benefit Fast Track, no separate amount of crisis funds is issued. Rather benefits are issued to crisis customers within crisis response time frames. Other - Describe: N/A 4.9 If you have a separate component, how do you determine crisis assistance benefits? Amount to resolve the crisis. $0 Other - Describe: N/A Crisis Requirements, 2604(c) 4.10 Do you accept applications for energy crisis assistance at sites that are geographically accessible to all households in the area to be served? Yes No Explain. Applications are available at all Zone offices. Emergency procedures include home visits when necessary, counseling, referrals, communication with suppliers, or other services and a 24-hour telephone number for requesting aid or reporting a crisis. Outreach activities assure that potentially eligible households are informed of the heating assistance and emergency assistance components of the program and have the opportunity to submit an application. Aging service area coordinators and the North Dakota Council of Community Action Agency Directors, representing the seven (7) regional community action agencies, have agreed to continue to provide outreach and intake function for LIHEAP heating assistance and crisis situations. Additionally, customers in crisis can reach out to local sheriff's offices for immediate and urgent support. In addition, the Department contracted with Community Options to provide outreach services which includes information to potential clients or current clients, providing applications, assist completing applications and obtaining required verifications. 4.11 Do you provide individuals who are individuals with a disability the means to: Submit applications for crisis benefits without leaving their homes? Yes No If No, explain. N/A Travel to the sites at which applications for crisis assistance are accepted? Yes No If No, explain. N/A If you answered "No" to both options in question 4.11, please explain alternative means of intake to those who are homebound or physically disabled? N/A Benefit Levels, 2605(c)(1)(B) 4.12 Indicate the maximum benefit for each type of crisis assistance offered. Winter Crisis $0.00 maximum benefit Summer Crisis $0.00 maximum benefit Year-round Crisis $500.00 maximum benefit 4.13 Do you provide in-kind (e.g. blankets, space heaters, fans) and/or other forms of benefits? Yes No If yes, Describe Emergency assistance can provide assistance for the following: Supplemental heating assistance, including unavoidable mandatory finance and other incidental charges, for households that are financially unable to pay all of the family share of a heat bill. The emergency assistance component may be used to justify re-computing the basic heating assistance benefit level if the financial shortage is expected to be long-term, or it may be used to pay the amount needed to resolve the current crisis, or a combination of both options. An eligible household may receive up to $500.00 per season for heating costs (including re-connection charges). SEE EMERGENCY DISASTER RESPONSE BELOW FOR EXCEPTION. if the household is financially unable to contribute all or part of their co-payment percentage to the purchase of the fuel. Amounts in excess of the seasonal maximum must be approved by the state office. (See policy sections below) 1. Repair or replacement, whichever is appropriate and cost effective, of a defective, inoperable, unsafe, or inefficient heating system or water heater for an eligible homeowner or an eligible renter with verifiable responsibility for such costs may be provided, depending on the availability of funds, weatherization or other resources, expected payback, and other related factors. The heating system includes chimney, air ducts, burners, tanks, pipes and all other components necessary to produce heat safely and efficiently. (No maximum for this portion of crisis assistance and includes the cost of equipment and replacement of heating system or parts.) 1. Minor home repairs or replacement components (excludes additions) to prevent the loss of home energy in the living unit of an eligible homeowner or a renter with verifiable responsibility for such costs. (up to $400/season) 1. Temporary shelter, temporary heating or cooling devices and/or other consumer type goods that may be needed to protect household members from a severe loss or lack of home energy. (Up to $100.00/season). 1. The state may delegate some or all of the responsibility for delivering the services described in 2, 3 and 4 above by administrative agreement with the Division of Community Services. 1. The costs necessary to prevent the loss of or to restore electrical service for an eligible household. (See Section N of the ND State Plan attachments document) 1. Supporting policy for #1: Supplemental Fuel 415-50-05-05 An eligible household may receive up to $500.00 per season for heating costs (including re-connection charges) if the household is financially unable to contribute all or part of their co-payment percentage to the purchase of the fuel. (For exceptions, see 415-50-15) Exception to Limitation for Emergency Services 415-50-15 Whenever an eligible household has an emergency fuel assistance need that exceeds the county maximum, the state approval should be requested. Very few requests for exceptions are expected inasmuch as community negotiations and individual households plans should usually restrict emergency assistance to the specified limits. Emergency Disaster Responses Additional enhancements to the LIHEAP emergency program may be implemented in the event of state or federal disaster declarations or other emergencies as determined by the department. To streamline the emergency process and ensure an effective and timely response to disaster-type emergencies, any or all of the following changes may be implemented as part of an emergency disaster response: Telephonic emergency applications with a verbal signature will be allowed. Worker must indicate applicant’s name and notate “Verbal Signature” in the applicant signature line of the emergency application. 1. Client statement will be allowed as an acceptable source of verification of income and expenses on the emergency application if currently acceptable sources of verification are not readily available. Worker must be sure to document the verification source used. 2. The seasonal maximum amount for supplemental fuel may be increased to accommodate the emergency. State office approval should be obtained for amounts that exceed the maximum amount. 3. If additional funding is available to the program, a temporary disaster assistance program may be considered. The temporary program may include but is not limited to: 4. 1)Extension of the heating season, 2) Additional assistance with heating costs, 3) Assistance with non-heating electric utility costs, or 4) A combination of the above options 4.14 Do you provide for equipment repair or replacement using crisis funds? Yes No If you answered "Yes" to question 4.14, you must complete question 4.15. 4.15 Check appropriate boxes below to indicate type(s) of assistance provided. Winter Crisis Summer Crisis Year-round Crisis Heating system repair Heating system replacement Cooling system repair Cooling system replacement Wood stove purchase Pellet stove purchase Solar panel(s) Utility poles / gas line hook-ups Other (Specify): N/A 4.16 Do any of the utility vendors you work with enforce a moratorium on shut offs? Yes No If you responded "Yes" to question 4.16, you must respond to question 4.17. 4.17 Describe the terms of the moratorium and any special dispensation received by LIHEAP clients during or after the moratorium period. Investor-owned utilities (there are four in the state) must follow the attached Public Service Comission disconnect rules. 4.18 If you experience a natural disaster, do you intend to utilize LIHEAP crisis funds to address disaster related crisis situations? Yes No If yes, describe Emergency Disaster Responses Additional enhancements to the LIHEAP emergency program may be implemented in the event of state or federal disaster declarations or other emergencies as determined by the department. To streamline the emergency process and ensure an effective and timely response to disaster-type emergencies, any or all of the following changes may be implemented as part of an emergency disaster response: 1. Telephonic emergency applications with a verbal signature will be allowed. Worker must indicate applicant’s name and notate “Verbal Signature” in the applicant signature line of the emergency application. 2. Client statement will be allowed as an acceptable source of verification of income and expenses on the emergency application if currently acceptable sources of verification are not readily available. Worker must be sure to document the verification source used. 3. The seasonal maximum amount for supplemental fuel may be increased to accommodate the emergency. State office approval should be obtained for amounts that exceed the maximum amount. 4. If additional funding is available to the program, a temporary disaster assistance program may be considered. The temporary program may include but is not limited to: 1) Extension of the heating season, 2) Additional assistance with heating costs, 3) Assistance with non-heating electric utility costs, or 4) A combination of the above options 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.