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 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 9 State Median Income 60.00% 10 10 State Median Income 60.00% 11 11 State Median Income 60.00% 12 11 State Median Income 60.00% 13 13 State Median Income 60.00% 14 14 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: 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 which meet all other component eligibility criteria may receive Cooling benefits without a corresponding medical need. Individuals with a disability? Yes No If yes, describe: Young children? Yes No If yes, describe: Households containing a child under age 6 which meet all other component eligibility criteria may receive Cooling benefits without a corresponding medical need. Households with high energy burdens? Yes No If yes, describe: Other? Documented Medical Need Yes No If yes, describe: In addition to meeting NYS's income and citizenship eligibility and living arrangement eligibility criteria, applicants for Cooling who do not have a member age 60 years or older or under age 6 in their household must have a medical condition, which is exacerbated by extreme heat and verified in writing by a physician, physician assistant or nurse practitioner. Additionally, households must not have a working air conditioner that is newer than five years or operable central air conditioning. Applicants are only eligible for a Cooling Assistance benefit once every five years. Applicants that are pended for a written statement from their physician, physician assistant, or nurse practitioner regarding their medical condition that cannot obtain documentation may contact the district and attest to both having a medical condition exacerbated by extreme heat and that they are not able to obtain written documentation. Explanations of policies for each "yes" checked above: Part of the eligiblity criteria for the Cooling component is that the household must contain an individual with a documented medical condition, or who is age 60 years or older, or under age 6. 3.4 Describe how you prioritize the provision of cooling assistance to vulnerable populations, e.g., benefit amounts, early application periods, etc. Applicants with a documented medical condition. Households containing a vulnerable member (aged 60 years or older, or under age 6) which meet all other component eligibility criteria may receive a Cooling benefit without a corresponding medical need. 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: NYS will authorize a HEAP payment up to $800 for a single window or portable air conditioner/fan, or up to $1,000 for a wall sleeve air conditioner unit if the household has an existing wall sleeve. The benefit amount is determined by the actual cost of equipment, material, and labor necessary to establish a cooling area. 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 $10 Maximum Benefit $1,000 3.7 Do you provide in-kind (e.g., fans, air conditioners) and/or other forms of benefits? Yes No If yes, describe. NYS does not provide a cash Cooling benefit; NYS only provides an air conditioner or fan if the household is eligible. The benefit amount is determined by the actual cost of equipment, material, and labor necessary to establish a cooling area and is issued directly to the vendor. The benefit is not applied to the client's electric bill, nor is it issued to the applicant as a cash benefit. 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.