4 CRISIS ASSISTANCE

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 1 State Median Income 54.14% 2 2 State Median Income 55.95% 3 3 State Median Income 57.07% 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 HHS Poverty Guidelines 150.00% 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. Households must meet one of the following conditions for the period of October 1 – March 31-Supplier refuses to deliver-Household has an overdue bill from supplier-Heating system requires repair or replacement-Household has less than 20% remaining in tank-Household has a disconnect notice or has already been disconnected-Household has an eviction notice for non-payment when heat is included in rent or paid in addition to rent Period of April 1 - September 30 -Household has an electric disconnect notice or has already been disconnected. Furnace Repair/Replacement is available year round or until the funds allocated are exhausted. 4.3 What constitutes a life-threatening crisis? An eligible household must receive some form of assistance no later than 18 hours after the household applies for emergency assistance. Life threatening situations include- 1. No heat in home due to primary heat source or electricity being disconnected 2. No heat in home due to furnace not operating 3. Household does not have alternate or temporary heat source4. Temperature is or will be less than 50 degrees within the 18 hour timeframe 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): All crisis households are priority 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): 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: 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: 4.9 If you have a separate component, how do you determine crisis assistance benefits? Amount to resolve the crisis. $0 Other - Describe: Disconnect assistance- Maximum of $2,400 annually Furnace Repair/Replacement - No maximum 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. There are 31 local DSS offices that applications can be taken to and faxed/scanned to our office in case of an crisis. 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. If necessary, local DSS staff will travel to home to assist with the application and then ensure it is sent to the State office. Travel to the sites at which applications for crisis assistance are accepted? Yes No If No, explain. If necessary, local DSS staff will travel to home to assist with the application and then ensure it is sent to the State office. 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? If necessary, local DSS staff will travel to home to assist with the application and then ensure it is sent to the State office. 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 $2,400.00 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 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): If a furnace is replaced and existing AC unit is not compatible, the AC unit may be replaced with emergency funds as well. 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. 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 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.