3 COOLING ASSISTANCE

Eligibility, 2605(c)(1)(A), 2605 (b)(2) - Assurance 2 3.1 Designate The income eligibility threshold used for the Cooling component: Add Household size Eligibility Guideline Eligibility Threshold 1 All Household Sizes HHS Poverty Guidelines 150.00% 3.2 Do you have additional eligibility requirements for Cooling assistance? Yes No 3.3 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: • Subsidized rent/utilities with additional separate utility cost: Households receiving subsidized rent assistance who receive a subsidy for utilities but who incur an additional out-of-pocket expense for utilities are eligible for LIHEAP; • Subsidized rent with utilities included: Households receiving subsidized rent assistance whose heating/cooling cost is included in their subsidized rent and do not incur an additional out-of-pocket heating or cooling expense are not eligible for LIHEAP; • Subsidized rent with rental cost: Households receiving subsidized rent assistance who pay rent but do not pay utilities are not eligible for LIHEAP; and, • Subsidized rent with no cost: Households receiving subsidized rent assistance who pay no rent and no utilities are not eligible for LIHEAP Renters with utilities included in the rent? Yes No If yes, describe: Households paying non-subsidized rent whose utility costs are included in their rent, even if no such cost is designated, are eligible for LIHEAP. Do you give priority in eligibility to: Older Adults (60 years or older)? Yes No If yes, describe: Age 60 and over: Two points are assigned to eligible households based on the inclusion of one or more household members age 60 or over as determined by birthdate data. Individuals with a disability? Yes No If yes, describe: Disability: Two points are assigned to eligible households having one or more members with a disability. Disability is defined as physical or mental impairment resulting in substantial reduction in the ability of an individual to care for themselves or carry out normal activities. When one or more members receive disability based income, the household is entitled to the points. A doctor's statement of current disability will be required for assignment of the point for this factor if the disabled member does not receive disability-based income. Young children? Yes No If yes, describe: Age five and under: Two points are assigned to eligible households based on the inclusion of one or more household members age five and under as determined by birthdate data. Households with high energy burdens? Yes No If yes, describe: Points are assigned to the household by determining the households' percentage of energy burden. The point allocation for energy burden is: (a) Zero points for zero to five percent energy burden; (b) One point for six to ten percent energy burden; (c) Two points for eleven to fifteen percent energy burden; or (d) Three points for sixteen percent or more energy burden. (2) Additional energy burden: If the household’s energy burden is for the use of propane, an additional two points will be allocated. Other? Yes No If yes, describe: Explanations of policies for each "yes" checked above: 3.4 Describe how you prioritize the provision of cooling assistance to vulnerable populations, e.g., benefit amounts, early application periods, etc. Households with vulnerable members; such as age 60 and over, age 5 and under, members with a disability, and for any household that is seeking assistance with bulk fuel propane are eligible for an additional benefit. Determination of Benefits 2605(b)(5) - Assurance 5, 2605(c)(1)(B) 3.5 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: Households with vulnerable members—such as individuals age 60 and over, children age 5 and under, and members with a disability—as well as households seeking assistance with bulk fuel (e.g., propane), are eligible for an additional LIHEAP benefit. Households that cut or gather their own firewood or whose utilities are included in their rent may receive a LIHEAP benefit, but do not receive the energy burden calculation. Benefit Levels, 2605(b)(5) - Assurance 5, 2605(c)(1)(B) 3.6 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 $70 Maximum Benefit $490 3.7 Do you provide in-kind (e.g., fans, air conditioners) and/or other forms of benefits? Yes No If yes, describe. 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.