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 03/31/2026 Cooling assistance 06/01/2026 08/31/2026 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 The Nebraska Department of Health and Human Services (DHHS) provides heating assistance to eligible households during the heating seas through March). DHHS may determine a household's eligibility for heating assistance after the heating season if a household applied for/requested LIHEAP assist the heating season and eligibility was not determined, eligibility was incorrectly determined, or a household had a current application (a pending economic assistance program case) during the heating season, and eligibility was not determined. • DHHS may begin determining eligibility for heating assistance prior to the beginning of the heating season. If this occurs, heating assistance paym be issued until the start of the heating season. DHHS will make this decision based on operational and technical capabilities. Eligibility staff will guidance if eligibility will be determined before the heating season begins. • DHHS currently provides a year-round crisis assistance program. For each program year (October through September), DHHS accepts and p applications and crisis assistance requests according to the earliest application date until DHHS determines that pending payments will exhaust avai the program year. Upon making this determination, DHHS will accept no more applications for crisis assistance for the program year. DHHS contracts with the Nebraska Department of Water, Energy, and Environment (DWEE) to administer the weatherization assistance pro The availability of the cooling assistance program and the variables used to determine eligible households will depend on the LIHEAP fundi and available for the current federal fiscal year. DHHS typically provides cooling assistance to eligible households during the cooling season (June t August). DHHS may determine a household's eligibility for cooling assistance after the cooling season in certain situations, such as eligibility for a timely request was not determined by the end of the cooling season or eligibility was incorrectly determined. • DHHS may determine a household's eligibility for cooling assistance prior to the beginning of the cooling season. If this occurs, cooling assistanc will not be issued until the beginning of the cooling season. DHHS will make this decision based on operational and technical capabilities. Eligib be notified via guidance if eligibility will be determined before the cooling season begins. • For heating or cooling eligible households, an extra payment may be made in the form of a supplemental payment or an increase in the regul payment. The supplemental payments may be processed and issued at any time during the current LIHEAP program year (October through Septemb for a supplemental payment for households that received heating or cooling assistance may be identified during or following the heating or cooling reason for the supplemental issuance may be due to circumstances including but not limited to high energy costs; extreme weather; disasters; pandem funding; or receipt of additional funding. For example, a supplemental payment may be issued in September (or any month of the year) for LIHEAP-eligible households that received assistance or for LIHEAP-eligible households that received cooling assistance if it identified excess funds exist. Processing and issuing supplementa late in the program year allows DHHS to more easily project the number of households that will receive the supplemental payment. These payments issued to either a provider or to the household. Supplemental payments are typically issued to the utility provider; however, below are some situatio supplemental payment would be issued to the household: The utility provider does not cooperate with DHHS in accepting payments; or, • An economically vulnerable household's utilities are included in rent. • Section 1.2: DHHS utilizes 9% of available funds for administrative and planning costs; however, a portion of the funds awarded to NDEE f weatherization are for administrative costs and planning costs. Thus, a portion of the expended administrative costs are considered in the amount for weatherization. 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 58.00% 58.00% Cooling assistance 18.00% 18.00% Summer crisis assistance 0.00% 0.00% Winter crisis assistance 0.00% 0.00% Year-round crisis assistance 3.00% 3.00% Weatherization assistance 10.00% 10.00% Carryover to the following federal fiscal year 2.00% 2.00% Administrative and planning costs 9.00% 9.00% Services to reduce home energy needs including needs assessment (Assurance 16) 0.00% 0.00% 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:) DHHS runs a year-round crisis assistance program at this time. DHHS provides year-round deposit assistance. DHHS may utilize additional funds for cooling assistance. DHHS may utilize additional funds for repair and replacement assistance. DHHS may utilize additional funds for window air conditioner assistance. DHHS may utilize additional funds for heating assistance for households that were eligible for heating assistance (within the rules of the program). DHHS may provide supplemental payments for heating and/or cooling eligible households depending on whether there are additional funds, disasters, pandemics, etc. DHHS may utilize additional funds for weatherization services. 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? N/A 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 For the purposes of calculating and treating income for LIHEAP eligibility, DHHS applies the rules and regulations from theSupplemental Nutrition Assistance Program, Title 475 Nebraska Administrative Code (NAC). As a result, some of the aformentioned income types may be considered income in some circumstances but excluded as income inother circumstances. For example, the earned income of a child age 17 or younger and attending elementary or secondary school at leasthalf-time is excluded. However, the income of a 16 or 17-year-old that is not attending school half-time must be counted. Some otherexamples inlcude but are not limited to: General Assistance; VISTA; WIOA; and reimbursments. DHHS does not deduct medical costs from gross income when determining eligibility. Thus, Medicare is not considered a deduction for LIHEAP. DHHS considers the gross amount of income a client is eligible for from Social Security to be countable unearned income, regardless of whether a portion of the Social Security is used to pay for a Medicare premium. DHHS applies an earned income disregard of 20% to gross countable earned income if a household passes the gross countableincome test. 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: https://iserve.nebraska.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. Weatherization Assistance Program. DHHS awards a portion of the LIHEAP funding to DWEE for weatherization assistance. DWEE award community action agencies to provide weatherization services. When a household requests assistance from DHHS with a furnace or air conditioner replacement assistance, the household is provided contact information for the agency that serves their community. 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 An applicant can create an account online and upload documents through their cell phone. Hidden for Section 1