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 1 State Median Income 60.00% 2 2 State Median Income 60.00% 3 3 State Median Income 60.00% 4 4 State Median Income 60.00% 5 5 State Median Income 60.00% 6 6 State Median Income 60.00% 7 7 State Median Income 60.00% 8 8 State Median Income 60.00% 9 8 State Median Income 60.00% 10 10 State Median Income 60.00% 11 11 State Median Income 60.00% 12 12 State Median Income 60.00% 13 13 State Median Income 60.00% 14 14 HHS Poverty Guidelines 150.00% 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 containing a member aged 60 years or older are considered vulnerable and can receive an additional $35 to their base Regular heater benefit. Individuals with a disability? Yes No If yes, describe: Households containing a member that is permanently disabled are considered vulnerable and can receive an additional $35 to their base Regular heater benefit. Young children? Yes No If yes, describe: Households containing a child under the age of 6 are considered vulnerable and can receive an additional $35 to their base Regular heater benefit. Households with high energy burdens? Yes No If yes, describe: Households with gross income in the lowest income tier at or below 130% of the Federal Poverty Level (FPL) receive an additional $61 to their base Regular heater benefit. This add-on is also applied to Regular heater benefits received by CE households in receipt of SNAP, federally funded PA, or Code A SSI. Other? Yes No If yes, describe: Explanations of policies for each "yes" checked above: Households containing a member aged 60 years or older are considered vulnerable and can receive an additional $35 to their base Regular heater benefit. Households containing a member that is permanently disabled are considered vulnerable and can receive an additional $35 to their base Regular heater benefit. Households containing a child under the age of 6 are considered vulnerable and can receive an additional $35 to their base Regular heater benefit. Households with gross income in the lowest income tier at or below 130% of the Federal Poverty Level (FPL) receive an additional $61 to their base Regular heater benefit. This add-on is also applied to Regular heater benefits received by CE households in receipt of SNAP, federally funded PA, or Code A SSI. 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. NYS provides early application access to households with a vulnerable member (under age 6, aged 60 or older, or permanently disabled). In addition, these households receive an additional $35 to their base Regular heater benefit if eligible. 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: 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 $21 Maximum Benefit $996 2.7 Do you provide in-kind (e.g., blankets, space heaters) and/or other forms of benefits?2 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.