Popup instructions for Module 1 (Grantee Survey)  | 
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Popup No.  | 
			Form Text over Hyperlink  | 
			URL or Popup Text  | 
		
1  | 
			Program Name:  | 
			If incorrect, click on the Grantee Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
2  | 
			Grantee Name:  | 
			If incorrect, click on the Grantee Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
3  | 
			Report Name:  | 
			If incorrect, click on the Grantee Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
4  | 
			Report Period:  | 
			If incorrect, click on the Report Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
5  | 
			Report Status:  | 
			Reports marked as ‘‘Saved with Warning’’ or ‘‘Saved and Validated’’ may be processed, but those marked as ‘‘Saved with Errors’’ need corrective action.  | 
		
6  | 
			Section Status:  | 
			Indication of each section’s status within the OLDC system.  | 
		
7  | 
			Initialized  | 
			Status Definition: Initialized - A new report form has been created but has not yet been saved.  | 
		
8  | 
			Edit-Saved  | 
			Status Definition: Edit - Saved. The Report Form will display one of three status. 1. Saved. The report form is saved. 2. Saved -- with Errors. The report form is saved and validated but there are errors on the saved form. The errors must be corrected and Validated again. 3. Saved -- with Warnings: The report form is saved and validated and there are some allowable errors on the saved form.  | 
		
9  | 
			Validated  | 
			Status Definition: Validated. The report form has been validated (i.e., calculations, required fields, and data accuracy are checked), and there are no errors on the saved form. The Form may now be Certified. The Report Status will be ‘‘Saved -- Validated’’.  | 
		
10  | 
			Certified  | 
			Status Definition: Certified. The Report Form will display one of two status. 1. Certified. The report form has been signed by an authorizing official but has not yet been submitted to ACF. 2. Certified -- with Warnings. The report form has been signed by an authorizing official but has not yet been submitted to ACF. Also, the report form is saved and validated (i.e., calculations, required fields, and data accuracy were checked), and there are some errors on the saved form. However, these errors are allowable by ACF and the report may still be submitted.  | 
		
11  | 
			Submitted  | 
			Status Definition: Submitted. The report form has been certified (signed) and sent to ACF or Submitted with Warnings: The report form has been certified (signed) and sent with warnings that are allowable by ACF.  | 
		
12  | 
			In Review  | 
			Status Definition: In Review. Regional or Central Office is reviewing the report and can no longer be edited by the grantee.  | 
		
13  | 
			C/O Approved  | 
			Status Definition: C/O Approved. The report form has been accepted by the Central Office and is no longer editable by the grantee.  | 
		
14  | 
			Grantee Name  | 
			Grantee Name  | 
		
15  | 
			Date  | 
			Date  | 
		
16  | 
			Telephone Number  | 
			Telephone Number  | 
		
17  | 
			Contact Person  | 
			Contact Person  | 
		
18  | 
			Email Address  | 
			Email Address  | 
		
19  | 
			HERE  | 
			http://www.acf.hhs.gov/programs/ocs/resource/funding-applications  | 
		
20  | 
			All Possible Funding Sources  | 
			All Federal funds available for LIHEAP for this Federal Fiscal Year (FFY) are listed in Section III. The amounts of most of these funds are pre-populated by HHS  | 
		
21  | 
			ALL OF FFY  | 
			All Federal funds available for LIHEAP for this Federal Fiscal Year (FFY) are listed in Section III. The amounts of most of these funds are pre-populated by HHS  | 
		
22  | 
			A. All Funds Except Leveraging Incentive Awards ( Items 1 - 8 )  | 
			A All Funds Except Leveraging Incentive Awards ( 1 - 8 )  | 
		
23  | 
			1. FFY LIHEAP Block Grant Allotment ( Net of Indian Tribal Set-Asides)  | 
			LIHEAP block grant allotment, net of any applicable set-asides to Indian Tribes/Tribal Organizations. Block grant allotments may only be used for purposes specified in the LIHEAP statute (Low-Income Home Energy Assistance Act, Title XXVI of Public Law 97-35, as amended) and in the HHS block grant regulations (45 CFR 96). This cell is pre-populated by HHS and not available for editing.  | 
		
24  | 
			2. FFY Emergency Contingency Funds ( Net of Indian Tribal Set-Asides)  | 
			Grantees may use these contingency funds for any purpose authorized under LIHEAP, including heating assistance, crisis assistance, weatherization, administrative costs, and carryover, subject to normal LIHEAP restrictions. Grantees should add these funds to their regular FFY block grant funds to determine limits on weatherization, administration and planning costs, and Assurance 16 activities. This cell is pre-populated by HHS and not available for editing.  | 
		
25  | 
			3. LIHEAP Block Grant Funds Realloted to FFY  | 
			LIHEAP block grant reallotment, net of any applicable set-asides to Indian Tribes/Tribal Organizations. This cell is pre-populated by HHS and not available for editing.  | 
		
26  | 
			4. Previous FFY Unobligated Emergency Contingency Funds, not Subject to 10% Carryover Limit  | 
			Unobligated Emergency Contingency Funds carried over from the previous FFY. This cell is pre-populated by HHS and available for editing if the funding source is applicable for the FFY  | 
		
27  | 
			5. Reserved  | 
			Previous FFY Unobligated Leveraging Incentive Award Funds. State’s FFY 2013 Leveraging Incentive Award Funds obligated in FFY 2014  | 
		
28  | 
			6. All Funds Carried Over From Previous FFY (except Funds in item 4 and 10 in this Section)  | 
			Please indicate the amount of funds carried over from the previous Federal Fiscal Year. Section 8626(b)(2)(B) of the LIHEAP statute provides that a LIHEAP grantee may request that up to 10 percent of its ‘‘funds payable’’ (i.e., LIHEAP block grant, emergency contingency funds, and oil overcharge funds designated for LIHEAP) be held available for the next fiscal year. This cell is pre-populated by HHS and available for editing.  | 
		
29  | 
			7. Petroleum Violation Escrow (Oil Overcharge) Funds Obligated in FFY  | 
			Please indicate the amount of P.V.E. funds obligated in the FFY. The Secretary of Energy distributed these funds in the 1980s as ‘‘Warner amendment,’’ Exxon, and Stripper Well funds or other oil overcharge distributions such as Diamond Shamrock or AMOCO. Such funds are considered to be Federal LIHEAP funds once designated by a LIHEAP grantee for LIHEAP.  | 
		
30  | 
			8. FFY Residential Energy Assistance Challenge (R.E.A.Ch.) Program  | 
			The Human Services Amendments of 1994 (Public Law 103-252) added Section 2607B to the LIHEAP statute, establishing the Residential Energy Assistance Challenge Program (REACH). REACH is designed to help low income households reduce their energy vulnerability. REACH funding is available in amounts up to $350,000 for States, and up to $50,000 for Tribes/Tribal Organizations and Territories. In addition, successful REACH applicants that also submit Energy Efficiency Education Services (EEES) proposals may be awarded additional funds up to $35,000 for States and up to $10,000 for Tribes/Tribal Organizations and Territories for those additional education services. This cell is pre-populated by HHS and not available for editing.  | 
		
31  | 
			B. Leveraging Incentive Award ( Items 9 - 10 )  | 
			Leveraging Incentive Award. (Items 9-10)  | 
		
32  | 
			9. FFY Leveraging Incentive Award  | 
			Leveraging incentive award funds obligated in the next Federal Fiscal year, if any. This program provides supplementary funds to LIHEAP grantees that acquire non-federal home energy resources for low income households. Leveraging incentive funds are awarded to those grantees that use their own or other non-Federal resources to expand the effect of the Federal LIHEAP dollars. The leveraging incentive funds are not subject to the 10% carryover limit for regular block grant funds. This cell is pre-populated by HHS and not available for editing.  | 
		
33  | 
			10. Previous FFY Leveraging Incentive Award obligated in FFY  | 
			Leveraging incentive award funds from the previous FFY, if any. This program provides supplementary funds to LIHEAP grantees that acquire non-federal home energy resources for low income households. Leveraging incentive funds are awarded to those grantees that use their own or other non-Federal resources to expand the effect of the Federal LIHEAP dollars. The leveraging incentive funds are not subject to the 10% carryover limit for regular block grant funds. This cell is pre-populated by HHS and available for editing.  | 
		
34  | 
			C. Estimated Total Sources of Funds (Items 1-10)  | 
			Estimated Total Sources of Funds (Items 1-10)  | 
		
35  | 
			11. Sum of Items 1-10. This should equal the sum in Section IV, Item 15.  | 
			This is a locked and calculated cell to indicate the total sources of all Federal funds available for LIHEAP for the Federal Fiscal Year. This total should equal the sum of Total Uses of Funds in Section IV. C. 15. Please note that this calculated sum will not update until the form is validated.  | 
		
36  | 
			ALL OF FFY  | 
			All Federal funds available for LIHEAP for this Federal Fiscal Year (FFY) are listed in Section III. The amounts of most of these funds are pre-populated by HHS  | 
		
37  | 
			All Possible Uses of Funds  | 
			
				‘‘Uses of
				Funds’’ represent a grantee’s obligation, not
				expenditure, of funds.  (In some cases, obligated LIHEAP funds
				are not actually expended until after the end of the Federal
				Fiscal Year (FFY)).  Include information on all funds/awards that
				were obligated for use in LIHEAP or that were obligated in or
				carried over to the next Federal Fiscal Year.  LIHEAP block grant
				funds that were not obligated by the end of the FFY are to be
				reported as funds carried over to the next FFY.  | 
		
38  | 
			Total Funds / Awards Funds  | 
			Indicate the amount obligated for each type of assistance and the amounts for other allowable activities for the Federal Fiscal Year.  | 
		
39  | 
			Average Household Benefit  | 
			Indicate the average benefit amount for households assisted during the entire Federal Fiscal Year for each type of assistance provided by the grantee. This is not requested for weatherization assistance because of the wide variety of allowable activities among the grantees.  | 
		
40  | 
			Maximum Annual Dollar Income for 4-person Household as of  | 
			
				For each type of
				assistance provided, list the maximum annual or annualized dollar
				income cutoff for a 4-person household that was in effect at the
				beginning of the Federal Fiscal Year (FFY). If the grantee used a
				higher dollar income cutoff for a specific group of households
				(such as elderly households) and a lower dollar income cutoff for
				everyone else, report the lower of the two income cutoffs.
				Indicate in the Notes section what the higher income cutoff is
				and to which specific group(s) it applies.  | 
		
41  | 
			A Type of LIHEAP Assistance (Items 1-4)  | 
			
				Indicate the amount of
				funds used for low-cost residential weatherization or
				other-energy-related home repairs, if any.  In the past, some
				grantees have reported LIHEAP and Department of Energy (DOE)
				weatherization funds together. Please exclude DOE weatherization
				assistance funds in your response to Section IV. Estimated Uses
				of LIHEAP Funds, Weatherization Assistance Benefits, (IV. A. 4).
				Also exclude the cost of administering the LIHEAP weatherization
				assistance component.  | 
		
42  | 
			1. Heating Assistance Benefits  | 
			
				Indicate the amount of
				funds used to provide heating assistance benefits.  Exclude the
				cost of administering the heating assistance component.  If
				applicable, include a note that indicates if the benefits include
				funds for other non-crisis assistance (please describe such
				assistance).  | 
		
43  | 
			2. Cooling Assistance Benefits  | 
			Indicate the amount of funds used to provide cooling assistance benefits, if any. Exclude the cost of administering the cooling assistance component. If applicable, include a note that indicates if the benefits include funds for other non-crisis assistance (please describe such assistance).  | 
		
44  | 
			3. Crisis Benefits by Type  | 
			
				In this section, indicate
				the total amount of crisis assistance benefits broken out by each
				applicable type of crisis assistance listed:  winter crisis,
				summer crisis, year‑round crisis (i.e., crisis programs
				that operate 10‑12 months during the Federal Fiscal
				Year), and other crisis benefits (such as responses to area-wide
				weather and supply-shortage emergencies declared by a public
				official, an emergency furnace repair/replacement program that is
				separate from the regular winter crisis assistance program, etc).
				 If applicable, briefly describe the ‘‘other’’
				category, e.g., emergency furnace repairs.  Exclude the cost of
				administering the crisis assistance component.  | 
		
45  | 
			a. Winter Crisis Benefits  | 
			Indicate the amount of funds used to provide Winter Crisis benefits, if any. Exclude the cost of administering the Winter Crisis component. If applicable, include a note that indicates any special cases for Winter Crisis funding.  | 
		
46  | 
			b. Summer Crisis Benefits  | 
			Indicate the amount of funds used to provide Summer Crisis benefits, if any. Exclude the cost of administering the Summer Crisis component. If applicable, include a note that indicates any special cases for Summer Crisis funding.  | 
		
47  | 
			c. Year-Round Crisis Benefits  | 
			Indicate the amount of funds used to provide Year-round Crisis benefits, if any. Exclude the cost of administering the Year-round Crisis component. If applicable, include a note that indicates any special cases for Year-round Crisis funding.  | 
		
48  | 
			d. Other Crisis Benefits:  | 
			
				Indicate the total amount
				of other crisis benefits, such as responses to area-wide weather
				and supply-shortage emergencies declared by a public official, an
				emergency furnace repair/replacement program that is separate
				from the regular winter crisis assistance program, if any. For
				each category that applies, please briefly describe the type of
				benefit in the field provided. For each category that applies,
				exclude the cost of administering the crisis assistance
				component.  | 
		
49  | 
			(1) Specify:  | 
			A State may have used LIHEAP funds to provide ‘‘other LIHEAP assistance’’ as described in its State’s LIHEAP Plan for FY 2014. For the most part, this would include ‘‘other crisis assistance,’’ such as furnace or air conditioner repairs. Such information would be included in items 3a. (3c. under) Total Crisis Benefits (item A.3). Other LIHEAP funds may have been used for non-crisis assistance/regular benefits, e.g., Supplemental Nutrition Assistance Program (SNAP) households that were provided a relatively small LIHEAP payment to increase the amount of SNAP benefits that they received (commonly referred to as heat or eat, or cool or eat programs). Add a note to indicate how much of the regular assistance funds include other non-crisis assistance funds. A corresponding note would also need to be included in the LHEAP Household Report for FY 2014.  | 
		
50  | 
			(2) Specify:  | 
			A State may have used LIHEAP funds to provide ‘‘other LIHEAP assistance’’ as described in its State’s LIHEAP Plan for FY 2014. For the most part, this would include ‘‘other crisis assistance,’’ such as furnace or air conditioner repairs. Such information would be included in items 3a. (3c. under) Total Crisis Benefits (item A.3). Other LIHEAP funds may have been used for non-crisis assistance/regular benefits, e.g., Supplemental Nutrition Assistance Program (SNAP) households that were provided a relatively small LIHEAP payment to increase the amount of SNAP benefits that they received (commonly referred to as heat or eat, or cool or eat programs). Add a note to indicate how much of the regular assistance funds include other non-crisis assistance funds. A corresponding note would also need to be included in the LHEAP Household Report for FY 2014.  | 
		
51  | 
			(3) Specify:  | 
			A State may have used LIHEAP funds to provide ‘‘other LIHEAP assistance’’ as described in its State’s LIHEAP Plan for FY 2014. For the most part, this would include ‘‘other crisis assistance,’’ such as furnace or air conditioner repairs. Such information would be included in items 3a. (3c. under) Total Crisis Benefits (item A.3). Other LIHEAP funds may have been used for non-crisis assistance/regular benefits, e.g., Supplemental Nutrition Assistance Program (SNAP) households that were provided a relatively small LIHEAP payment to increase the amount of SNAP benefits that they received (commonly referred to as heat or eat, or cool or eat programs). Add a note to indicate how much of the regular assistance funds include other non-crisis assistance funds. A corresponding note would also need to be included in the LHEAP Household Report for FY 2014.  | 
		
52  | 
			4. Weatherization Assistance Benefits  | 
			
				Indicate the amount of
				funds used for low-cost residential weatherization or
				other-energy-related home repairs, if any.  In the past, some
				grantees have reported LIHEAP and Department of Energy (DOE)
				weatherization funds together. Please exclude DOE weatherization
				assistance funds in your response to Section IV. Estimated Uses
				of LIHEAP Funds, ‘‘Weatherization Assistance
				Benefits’’, (IV. A. 4). Also exclude the cost of
				administering the LIHEAP weatherization assistance
				component.  | 
		
53  | 
			Bill Payment-Assisted Household Main Fuel  | 
			
				Average Annual Main
				Heating Fuel Bill Data:  Line B4 requires grantees to report the
				average annual main heating fuel bill for those households who
				have 12 consecutive months of main fuel and electric bill data
				(as reported in B1).  To report this data, grantees will need to
				collect complete annual bill information (12 consecutive months)
				from each bill payment-assisted household¿s main fuel
				vendor.  This data includes all required customer payments, such
				as monthly service charge, usage charge, and taxes. However,
				expenditures should exclude optional charges such as appliance
				repair contracts, equipment purchases, and other special
				services.   | 
		
54  | 
			All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
			All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
		
55  | 
			All Households  | 
			All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
		
56  | 
			Electricity  | 
			All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
		
57  | 
			Natural Gas  | 
			All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
		
58  | 
			Fuel Oil  | 
			All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
		
59  | 
			Propane  | 
			All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
		
60  | 
			Other Fuels  | 
			All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
		
61  | 
			5. Average Annual Total LIHEAP Benefit per Household (including Heating, Cooling, Crisis, Supplemental Benefits)  | 
			Average Annual Total LIHEAP Benefit per Household (including Heating, Cooling, Crisis, Supplemental Benefits). Report for all households with 12 consecutive months of bill data for both the main fuel and electricity. Do not include equipment repair and replacement or weatherization assistance. This data should only reflect financial bill payment assistance.  | 
		
62  | 
			B. Other Permitted Uses of LIHEAP Funds ( Items 6 - 14 )  | 
			Other Permitted Uses of LIHEAP Funds  | 
		
63  | 
			6. Nominal Payments  | 
			Include only those households that receive a LIHEAP benefit payment that deviates from the state’s regular payment matrix because the household is a SNAP recipient and has a minimal energy burden.  | 
		
64  | 
			7. FFY Unobligated Funds (excluding funds in Items 8 & 9) Carried Over to next FFY  | 
			
				Please update this amount
				as necessary. If money was returned to HHS due to LIHEAP statute
				limits, please indicate so in the ‘‘Notes’’
				field at the bottom of this form.  | 
		
65  | 
			8. FFY Allowable Unobligated Emergency Contingency Funds, not Subject to 10% Carryover Limit, Obligated in next FFY  | 
			Indicate FFY unobligated emergency contingency funds obligated in the next FFY, if any. Please note any special circumstances in the ‘‘Notes’’ field at the bottom of the form.  | 
		
66  | 
			9. FFY Leveraging Incentive Award Obligated in next FFY  | 
			Indicate FFY leveraging incentive award funds obligated in the next FFY, if any. Section 96.87(k) of the HHS block grant regulations provides that leveraging incentive award funds must be obligated in the FFY in which they are awarded or in the following FFY. Please note any special circumstances in the ‘‘Notes’’ field at the bottom of the form.  | 
		
67  | 
			10. Reserved  | 
			Indicate FFY Emergency Contingency Funds obligated in the next FFY. Grantees may use these contingency funds for any purpose authorized under LIHEAP, including heating assistance, crisis assistance, weatherization, administrative costs, and carryover, subject to normal LIHEAP restrictions. However, grantees must obligate at least 90 percent of the total of these funds and their regular block grant funds by the end of the FFY. Please note any special circumstances in the ‘‘Notes’’ field at the bottom of the form.  | 
		
68  | 
			11. FFY LIHEAP Block Grant Allotment Used to Identify, Develop & Demonstrate Leveraging Incentive Activities  | 
			
				Indicate the amount of the
				grantee’s LIHEAP block grant allotment that was used, if
				any, to identify, develop, and demonstrate leveraging
				activities  | 
		
69  | 
			12. Amount for Assurance 16 Activities  | 
			
				Indicate the amount, if
				any, of the LIHEAP block grant allotment used to carry out
				‘‘Assurance 16 activities’’, i.e.,
				services that encourage and enable households to reduce their
				home energy needs and thereby the need for energy assistance
				(including needs assessment, counseling, and assistance with
				energy vendors).  | 
		
70  | 
			13. FFY Residential Energy Assistance Challenge (R.E.A.Ch.) Program  | 
			Indicate the amount, if any, of REACH funds used to help low income households reduce their energy vulnerability. Please note any special circumstances in the ‘‘Notes’’ field at the bottom of the form  | 
		
71  | 
			14. Administration/Planning Costs  | 
			
				Indicate the amount of
				funds obligated for administration and planning costs.  The
				amount should include (a) all grantee and local administration
				and planning costs, and (b) both direct and indirect costs
				charged as administration and planning costs for the
				program.  | 
		
72  | 
			C. Estimated Total Uses of Funds (Items 1-4 and 6-14)  | 
			Estimated Total Uses of Funds  | 
		
73  | 
			15. Sum of Items 1-4 and 6-14. This should equal the sum in Section III. Column C, Item 11.  | 
			
				This is a locked and
				calculated cell to indicate the total uses of all Federal funds
				available for LIHEAP for this federal fiscal year.  | 
		
74  | 
			Q1. Obligated funding for a given type of assistance in current FFY, but will serve households in the subsequent FFY  | 
			Q1. Select the appropriate answer (‘yes’ or ‘no’) to indicate whether your State obligated funding for a given type of assistance in FFY 2014, but will serve households in the subsequent FFY. Please include clarifications in the ‘Notes’ section of the form along with the Survey’s Section and item number that is being noted.  | 
		
75  | 
			Q2. Average Household Benefits are estimated due to unique program operation, rather than directly calculated  | 
			Q2. Select the appropriate answer (‘yes’ or ‘no’) to indicate whether your State¿s Average Household Benefit data points are estimated due to unique program operation, rather than directly calculated. Please include clarifications in the ‘Notes’ section of the form along with the Survey¿s Section and item number that is being noted.  | 
		
76  | 
			Notes :  | 
			Any clarifications of a grantee’s response should be indicated in the ‘‘Notes’’ section of the Survey along with the Survey’s section and item number that is being noted.  | 
		
Popup instructions for Module 2 (LIHEAP Performance Measures)  | 
		||
Popup No.  | 
			Form Text over Hyperlink  | 
			URL or Popup Text  | 
		
77  | 
			Program Name:  | 
			If incorrect, click on the Grantee Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
78  | 
			Grantee Name:  | 
			If incorrect, click on the Grantee Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
79  | 
			Report Name:  | 
			If incorrect, click on the Grantee Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
80  | 
			Report Period:  | 
			If incorrect, click on the Report Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
81  | 
			Report Status:  | 
			Reports marked as ‘‘Saved with Warning’’ or ‘‘Saved and Validated’’ may be processed, but those marked as ‘‘Saved with Errors’’ need corrective action.  | 
		
82  | 
			Section Status:  | 
			Indication of each section’s status within the OLDC system.  | 
		
83  | 
			Initialized  | 
			Status Definition: Initialized - A new report form has been created but has not yet been saved.  | 
		
84  | 
			Edit-Saved  | 
			Status Definition: Edit - Saved. The Report Form will display one of three status. 1. Saved. The report form is saved. 2. Saved -- with Errors. The report form is saved and validated but there are errors on the saved form. The errors must be corrected and Validated again. 3. Saved -- with Warnings: The report form is saved and validated and there are some allowable errors on the saved form.  | 
		
85  | 
			Validated  | 
			Status Definition: Validated. The report form has been validated (i.e., calculations, required fields, and data accuracy are checked), and there are no errors on the saved form. The Form may now be Certified. The Report Status will be ‘‘Saved -- Validated’’.  | 
		
86  | 
			Certified  | 
			Status Definition: Certified. The Report Form will display one of two status. 1. Certified. The report form has been signed by an authorizing official but has not yet been submitted to ACF. 2. Certified -- with Warnings. The report form has been signed by an authorizing official but has not yet been submitted to ACF. Also, the report form is saved and validated (i.e., calculations, required fields, and data accuracy were checked), and there are some errors on the saved form. However, these errors are allowable by ACF and the report may still be submitted.  | 
		
87  | 
			Submitted  | 
			Status Definition: Submitted. The report form has been certified (signed) and sent to ACF or Submitted with Warnings: The report form has been certified (signed) and sent with warnings that are allowable by ACF.  | 
		
88  | 
			In Review  | 
			Status Definition: In Review. Regional or Central Office is reviewing the report and can no longer be edited by the grantee.  | 
		
89  | 
			C/O Approved  | 
			Status Definition: C/O Approved. The report form has been accepted by the Central Office and is no longer editable by the grantee.  | 
		
90  | 
			Grantee Name  | 
			Grantee Name  | 
		
91  | 
			Date  | 
			Date  | 
		
92  | 
			Telephone Number  | 
			Telephone Number  | 
		
93  | 
			Contact Person  | 
			Contact Person  | 
		
94  | 
			Email Address  | 
			Email Address  | 
		
95  | 
			V. ENERGY BURDEN TARGETING  | 
			
				Energy burden is the
				percentage of household income spent on home energy costs.   For
				example, high burden households are those that spend more of
				their income on home energy costs.  | 
		
96  | 
			Bill Payment- Assisted Household Main Heating Fuel  | 
			
				Part V of the Performance
				Measure Report form counts those households who received LIHEAP
				bill payment assistance in FFY 2015.  ‘‘Bill payment
				assistance’’ includes any LIHEAP benefits used to pay
				a share of household energy bills, including utility deposits. 
				This includes heating, cooling, crisis, and supplemental
				assistance.  | 
		
97  | 
			All Households  | 
			
				Many of the fields in Part
				V require specific information regarding home energy.  For
				example, average annual income and average LIHEAP benefit data is
				broken out by main heating fuel.  Therefore, at the time of
				application, grantees will need to ask each household to identify
				their main heating fuel type (i.e., Natural Gas, Electricity,
				Fuel Oil, Propane, or Other Fuels).  | 
		
98  | 
			Electricity  | 
			
				Many of the fields in Part
				V require specific information regarding home energy.  For
				example, average annual income and average LIHEAP benefit data is
				broken out by main heating fuel.  Therefore, at the time of
				application, grantees will need to ask each household to identify
				their main heating fuel type (i.e., Natural Gas, Electricity,
				Fuel Oil, Propane, or Other Fuels).  | 
		
99  | 
			Natural Gas  | 
			
				Many of the fields in Part
				V require specific information regarding home energy.  For
				example, average annual income and average LIHEAP benefit data is
				broken out by main heating fuel.  Therefore, at the time of
				application, grantees will need to ask each household to identify
				their main heating fuel type (i.e., Natural Gas, Electricity,
				Fuel Oil, Propane, or Other Fuels).  | 
		
100  | 
			Fuel Oil  | 
			
				Many of the fields in Part
				V require specific information regarding home energy.  For
				example, average annual income and average LIHEAP benefit data is
				broken out by main heating fuel.  Therefore, at the time of
				application, grantees will need to ask each household to identify
				their main heating fuel type (i.e., Natural Gas, Electricity,
				Fuel Oil, Propane, or Other Fuels).  | 
		
101  | 
			Propane  | 
			
				Many of the fields in Part
				V require specific information regarding home energy.  For
				example, average annual income and average LIHEAP benefit data is
				broken out by main heating fuel.  Therefore, at the time of
				application, grantees will need to ask each household to identify
				their main heating fuel type (i.e., Natural Gas, Electricity,
				Fuel Oil, Propane, or Other Fuels).  | 
		
102  | 
			Other Fuels  | 
			
				Many of the fields in Part
				V require specific information regarding home energy.  For
				example, average annual income and average LIHEAP benefit data is
				broken out by main heating fuel.  Therefore, at the time of
				application, grantees will need to ask each household to identify
				their main heating fuel type (i.e., Natural Gas, Electricity,
				Fuel Oil, Propane, or Other Fuels).  | 
		
103  | 
			A. Unduplicated Number of LIHEAP Bill Payment-Assisted Households  | 
			
				Section A includes all
				households who received LIHEAP bill payment assistance during the
				reporting period. This data is pre-populated from the Household
				Report form. Bill payment assistance includes any LIHEAP benefits
				used to pay a share of household energy bills.  This includes
				heating, cooling, and crisis assistance.  | 
		
104  | 
			B. All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
			
				Section B includes only
				those households from Section A for which the grantee can obtain
				the average annual energy bill (12 consecutive months of usage)
				for both main heating fuel and electricity.  | 
		
105  | 
			1. Unduplicated Number of Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
			Number of Households with Complete Bill Data. Line B1 requires grantees to report the number of bill payment assisted households for which they can obtain the average annual energy bill (12 consecutive months of billing history) for both main heating fuel and electricity. Similar to other data in this report, grantees are first asked to report the total number of bill payment assisted households with complete annual bill data, and then break these households down by main heating fuel type.  | 
		
106  | 
			2. Average Annual Household Income  | 
			Average Annual Household Income: Line B2 requires grantees to report average annual household income for those households with 12 consecutive months of both main fuel and electric bill data (as reported on Line B1). Average annual household income should be calculated in the same way it is calculated for the annual LIHEAP Household Report Form, using gross income. Zero income households should be included in this calculation. Grantees are asked to report the average annual income for all households with complete annual bill data, and then further break this data out by main fuel type.  | 
		
107  | 
			3. Average Annual Total LIHEAP Benefit per Household (including Heating, Cooling, Crisis, Supplemental Benefits)  | 
			
				Average Annual Total
				LIHEAP Benefit per Household:  Line B3 requires grantees to
				report the total average annual per household LIHEAP Bill Payment
				Assistance Benefit(s) for those households with 12 consecutive
				months of both main fuel and electric bill data (as reported on
				Line B1).  This should include any heating, cooling, crisis, and
				supplemental assistance used to help pay household energy bills
				(this includes utility deposits).  | 
		
108  | 
			4. Average Annual Main Heating Fuel Bill  | 
			
				Average Annual Main
				Heating Fuel Bill Data:  Line B4 requires grantees to report the
				average annual main heating fuel bill for those households who
				have 12 consecutive months of main fuel and electric bill data
				(as reported in B1).  To report this data, grantees will need to
				collect complete annual bill information (12 consecutive months)
				from each bill payment-assisted household¿s main fuel
				vendor.  This data includes all required customer payments, such
				as monthly service charge, usage charge, and taxes. However,
				expenditures should exclude optional charges such as appliance
				repair contracts, equipment purchases, and other special
				services.  | 
		
109  | 
			5. Average Annual Electricity Bill  | 
			Average Annual Electricity Bill: Line B5 requires grantees to report the average annual electricity bill for those households who have 12 consecutive months of main fuel and electric bill data (as reported in B1). To report this data, the grantee will need to collect annual bill information (12 consecutive months) from each bill payment-assisted household¿s electricity vendor. This data includes all required customer payments, such as monthly service charge, usage charge, and taxes. However, expenditures should exclude optional charges such as appliance repair contracts, equipment purchases, and other special services. For households whose main fuel is electricity, only the electric bill will need to be collected.  | 
		
110  | 
			6. Average Annual Total Residential Energy Bill  | 
			Total Annual Residential Energy Bill: Line B6 automatically adds together the average annual Main Heating Fuel and Electricity bill data to calculate average annual residential energy bill.  | 
		
111  | 
			7. Average Annual Burden Before Receiving LIHEAP  | 
			Average Annual Energy Burden before Receiving LIHEAP: Line B7 automatically divides the average annual residential energy bill by the average annual income to calculate average annual energy burden before LIHEAP benefits were awarded.  | 
		
112  | 
			8. Average Annual Burden After Receiving LIHEAP  | 
			Average Annual Energy Burden after Receiving LIHEAP: Line B8 automatically subtracts the average annual LIHEAP benefit amount from the annual residential energy bill - then divides the adjusted annual energy bill by the average annual income to calculate energy burden after LIHEAP.  | 
		
113  | 
			9. Average Percentage Point Change in Energy Burden  | 
			Percentage Point Change in Energy Burden: Line B9 automatically calculates the percentage point difference between pre-LIHEAP and post-LIHEAP energy burden.  | 
		
114  | 
			10. Average Percentage Reduction in Energy Burden  | 
			Percentage Point Change in Energy Burden: Line B10 automatically calculates the percentage difference between pre-LIHEAP and post-LIHEAP energy burden.  | 
		
115  | 
			C. High Burden Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
			
				Section C contains the
				same data elements as Section B.  However Section C only includes
				(highlights) those households from section B with the highest
				energy burden.  | 
		
116  | 
			1. Unduplicated Number of High Burden Households (Top 25%) with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
			High Burden Households. Line C1 asks grantees to report the number of high burden households with complete energy bill information, and then the number of high burden households by main heating fuel type.  | 
		
117  | 
			2. Average Annual Household Income for High Burden Households  | 
			Average Annual Household Income for High Burden Households: Line C2 asks grantees to report average annual household income for those high burden households identified on Line C1. Grantees are asked to report the average annual income for all high burden households, as well as the average annual income of high burden households within each main fuel type.  | 
		
118  | 
			3. Average Annual Total LIHEAP Benefit per High Burden Household (including Heating, Cooling, Crisis, Supplemental Benefits)  | 
			Average Annual LIHEAP Bill Payment Assistance Benefit for High Burden Households: Line C3 requires grantees to report average annual LIHEAP Benefit for those high burden households identified in line C1. Grantees are asked to report the average bill payment assistance benefit for all high burden households, as well as the average bill payment assistance benefit of high burden households within each fuel type.  | 
		
119  | 
			4. Average Annual Main Heating Fuel Bill for High Burden Households  | 
			Average Annual Main Heating Fuel Bill Data for High Burden Households: Line C4 requires grantees to report the average annual main heating fuel bill (12 consecutive months) for those high burden households identified in Line C1.  | 
		
120  | 
			5. Average Annual Electricity Bill for High Burden Households  | 
			Average Annual Electricity Bill for High Burden Households: Section C5 requires grantees to report the average annual electricity bill for those high burden households identified in Section C1.  | 
		
121  | 
			6. Average Annual Total Residential Energy Bill for High Burden Households  | 
			Total Annual Residential Energy Bill for High Burden Households: Line C6 automatically adds together the average annual Main Heating Fuel and Electricity bill data to calculate average annual residential energy bill for high burden households.  | 
		
122  | 
			7. Average Annual Burden Before Receiving LIHEAP for High Burden Households  | 
			Average Annual Energy Burden of High Burden Households before Receiving LIHEAP: Line C7 automatically divides the average annual residential energy bill by the average annual income to calculate average annual energy burden of high burden households before receiving LIHEAP.  | 
		
123  | 
			8. Average Annual Burden After Receiving LIHEAP for High Burden Households  | 
			Average Annual Energy Burden of High Burden Households after Receiving LIHEAP: Line C8 automatically subtracts the average annual LIHEAP benefit amount from the annual residential energy bill¿then divides the adjusted annual energy bill by the average annual income to calculate energy burden for high burden households after receiving LIHEAP.  | 
		
124  | 
			9. Average Percentage Point Change in Energy Burden for High Burden Households  | 
			Percentage Point Change in Energy Burden among High Burden Households: Line C9 automatically calculates the percentage point difference between pre-LIHEAP and post-LIHEAP energy burden among high burden households.  | 
		
125  | 
			10. Average Percentage Reduction in Energy Burden for High Burden Households  | 
			Percentage Point Change in Energy Burden among High Burden Households: Line C10 automatically calculates the percentage difference between pre-LIHEAP and post-LIHEAP energy burden among high burden households.  | 
		
126  | 
			D. Benefit Targeting Index for High Burden Households:  | 
			Section D uses information collected in Sections A-C to automatically calculate the Benefit Targeting Index. This index measure tells us whether high energy burden households receive higher LIHEAP benefits than average households. A Benefit Targeting Index of over 100 means that high energy burden households receive a greater LIHEAP benefit than average households.  | 
		
127  | 
			E. Burden Reduction Targeting Index for High Burden Households:  | 
			Section E uses information collected in Sections A-C to automatically calculate the Energy Burden Reduction Index. This index tells us whether high energy burden households have a larger share of their energy bill paid with LIHEAP than average households. An Energy Burden Reduction Index of over 100 means that high energy burden households are seeing more of their energy burden reduced with LIHEAP than average households.  | 
		
128  | 
			VI. RESTORATION OF HOME ENERGY SERVICE  | 
			
				One core purpose of LIHEAP
				is to ensure that low-income households have access to necessary
				home energy services.   By restoring services to clients who do
				not currently have access to home energy, the program is
				eliminating a significant risk to the health and safety of
				low-income households.  | 
		
129  | 
			Energy Source (where LIHEAP benefit was applied)  | 
			
				The data fields in Part VI
				of the Performance Measures Report form require specific
				information regarding the current status of household home energy
				service.  Many grantees already ask households to report whether
				or not they currently have home energy service at the time of
				LIHEAP application.  However, to complete this report, grantees
				would need to go a step further to determine and record whether
				the household:  | 
		
130  | 
			A. All Occurrences of LIHEAP Households that Had:  | 
			
				For both Parts VI and VII,
				grantees should count all LIHEAP households identified in the
				LIHEAP Household Report and Grantee Survey.  | 
		
131  | 
			All Occurrences  | 
			
				For both Parts VI and VII,
				grantees should count all LIHEAP households identified in the
				LIHEAP Household Report and Grantee Survey.  | 
		
132  | 
			Electricity  | 
			
				The data fields in Part VI
				of the Performance Measures Report form require specific
				information regarding the current status of household home energy
				service.  Many grantees already ask households to report whether
				or not they currently have home energy service at the time of
				LIHEAP application.  However, to complete this report, grantees
				would need to go a step further to determine and record whether
				the household:  | 
		
133  | 
			Natural Gas  | 
			
				The data fields in Part VI
				of the Performance Measures Report form require specific
				information regarding the current status of household home energy
				service.  Many grantees already ask households to report whether
				or not they currently have home energy service at the time of
				LIHEAP application.  However, to complete this report, grantees
				would need to go a step further to determine and record whether
				the household:  | 
		
134  | 
			Fuel Oil  | 
			
				The data fields in Part VI
				of the Performance Measures Report form require specific
				information regarding the current status of household home energy
				service.  Many grantees already ask households to report whether
				or not they currently have home energy service at the time of
				LIHEAP application.  However, to complete this report, grantees
				would need to go a step further to determine and record whether
				the household:  | 
		
135  | 
			Propane  | 
			
				The data fields in Part VI
				of the Performance Measures Report form require specific
				information regarding the current status of household home energy
				service.  Many grantees already ask households to report whether
				or not they currently have home energy service at the time of
				LIHEAP application.  However, to complete this report, grantees
				would need to go a step further to determine and record whether
				the household:  | 
		
136  | 
			Other Fuels  | 
			
				The data fields in Part VI
				of the Performance Measures Report form require specific
				information regarding the current status of household home energy
				service.  Many grantees already ask households to report whether
				or not they currently have home energy service at the time of
				LIHEAP application.  However, to complete this report, grantees
				would need to go a step further to determine and record whether
				the household:  | 
		
137  | 
			1. Energy Service Restored After Disconnection  | 
			Number of All Occurrences of LIHEAP Assisted Households that had Energy Service Restored after Disconnection: Line A1 requires grantees to report on the number of occurrences for which LIHEAP assistance led to the restoration of a household’s energy service after a disconnection. (Note: Households for whom the primary energy service was restored should be counted even if they were able to heat or cool their home in another way). The total number of occurrences is an auto-calculated sum of occurrences for each applicable energy source. Note: In this case, ‘‘energy source’’ is the fuel source where the LIHEAP benefit is being applied. In some cases, this may not be the household¿s primary fuel source.  | 
		
138  | 
			2. Fuel Delivered to Home that Ran Out of Fuel  | 
			Number of All Occurrences of LIHEAP Assisted Households that had Fuel Delivered after the Home Ran out of Fuel: Line A2 requires grantees to report on the number of occurrences for which LIHEAP resulted in delivery of fuel after a household had no fuel. (Note: Households should be counted even if they were able to use something other than their main fuel source to temporarily heat their home.) The total number of occurrences is an auto-calculated sum of occurrences for each applicable energy source. Note: In this case, ‘‘energy source’’ is the fuel source where the LIHEAP benefit is being applied. In some cases, this may not be the household’s primary fuel source.  | 
		
139  | 
			3. Repair/Replacement of Inoperable Home Energy Equipment  | 
			Number of All Occurrences of LIHEAP Assisted Households that received Repair or Replacement of Inoperable Equipment: Line A3 requires grantees to report the number of occurrences of households who had inoperable heating or cooling equipment repaired or replaced with LIHEAP funds. (Note: Households should be counted even if they were able to use something other than their main equipment to temporarily heat or cool their home.) The total number of occurrences is an auto-calculated sum of occurrences for each applicable energy source. Note: In this case, ‘‘energy source’’ is the fuel source where the LIHEAP benefit is being applied. In some cases, this may not be the household’s primary fuel source.  | 
		
140  | 
			VII. PREVENTION OF LOSS OF HOME ENERGY SERVICE  | 
			
				By preventing the loss of
				home energy service to at-risk households, LIHEAP can eliminate
				the costs associated with service restoration (e.g., reconnection
				charges) and can minimize health and safety risks.  | 
		
141  | 
			Energy Source (where LIHEAP benefit was applied)  | 
			
				For both Parts VI and VII,
				grantees should count all LIHEAP households identified in the
				LIHEAP Household Report and Grantee Survey.  | 
		
142  | 
			A. All Occurrences of LIHEAP Households that Had:  | 
			
				The data fields in Part
				VII of the Performance Measures Report form require specific
				information regarding current status of home energy service, and
				more specifically, whether or not a household is at risk of
				losing their home energy service.  Situations where a LIHEAP
				benefit would prevent a loss of home energy service include:  | 
		
143  | 
			All Occurrences  | 
			
				The data fields in Part
				VII of the Performance Measures Report form require specific
				information regarding current status of home energy service, and
				more specifically, whether or not a household is at risk of
				losing their home energy service.  Situations where a LIHEAP
				benefit would prevent a loss of home energy service include:  | 
		
144  | 
			Electricity  | 
			
				The data fields in Part
				VII of the Performance Measures Report form require specific
				information regarding current status of home energy service, and
				more specifically, whether or not a household is at risk of
				losing their home energy service.  Situations where a LIHEAP
				benefit would prevent a loss of home energy service include:  | 
		
145  | 
			Natural Gas  | 
			
				The data fields in Part
				VII of the Performance Measures Report form require specific
				information regarding current status of home energy service, and
				more specifically, whether or not a household is at risk of
				losing their home energy service.  Situations where a LIHEAP
				benefit would prevent a loss of home energy service include:  | 
		
146  | 
			Fuel Oil  | 
			
				The data fields in Part
				VII of the Performance Measures Report form require specific
				information regarding current status of home energy service, and
				more specifically, whether or not a household is at risk of
				losing their home energy service.  Situations where a LIHEAP
				benefit would prevent a loss of home energy service include:  | 
		
147  | 
			Propane  | 
			
				The data fields in Part
				VII of the Performance Measures Report form require specific
				information regarding current status of home energy service, and
				more specifically, whether or not a household is at risk of
				losing their home energy service.  Situations where a LIHEAP
				benefit would prevent a loss of home energy service include:  | 
		
148  | 
			Other Fuels  | 
			
				The data fields in Part
				VII of the Performance Measures Report form require specific
				information regarding current status of home energy service, and
				more specifically, whether or not a household is at risk of
				losing their home energy service.  Situations where a LIHEAP
				benefit would prevent a loss of home energy service include:  | 
		
149  | 
			1. Past Due Notice or Utility Disconnect Notice  | 
			Number of All Occurrences of LIHEAP Assisted Households that had a Utility Past-Due or Disconnect Notice and Receipt of LIHEAP Benefits Resulted in Continuance of Home Energy Service: Line A1 requires grantees to report the number of occurrences of households that had a past due or disconnect notice at the time of application and receipt of LIHEAP benefit(s) resulted in continuance of home energy service. Households who are already disconnected should not be counted in this section. The total number of occurrences is an auto-calculated sum of occurrences for each applicable energy source. Note: In this case, ‘‘energy source’’ is the fuel source where the LIHEAP benefit is being applied. In some cases, this may not be the household’s primary fuel source.  | 
		
150  | 
			2. Imminent Risk of Running out of Fuel  | 
			Number of All Occurrences of LIHEAP Assisted Households that were at Imminent Risk of Running out of Fuel and Receipt of LIHEAP Benefit Resulted in Delivery of Fuel: Line A2 requires grantees to report the number of occurrences of households that were at imminent risk of running out of fuel at the time of LIHEAP application and receipt of LIHEAP benefit(s) resulted in the delivery of fuel. Households who are already out of fuel should not be counted in this section. The total number of occurrences is an auto-calculated sum of occurrences for each applicable energy source. Note: In this case, ‘‘energy source’’ is the fuel source where the LIHEAP benefit is being applied. In some cases, this may not be the household’s primary fuel source.  | 
		
151  | 
			3. Repair/Replacement of Operable Equipment to Prevent Imminent Home Energy Loss  | 
			Number of All Occurrences of LIHEAP Assisted Households where Repair/Replacement of Operable Home Energy Equipment prevented loss of Home Energy Service: Line A3 requires grantees to report the number of occurrences of households for which LIHEAP Heating/Cooling equipment repair or replacement prevented loss of home energy service. Households whose heating or cooling equipment is inoperable (or red-tagged) at the time of application or home energy audit should not be counted in this section. The total number of occurrences is an auto-calculated sum of occurrences for each applicable energy source. Note: In this case, ‘‘energy source’’ is the fuel source where the LIHEAP benefit is being applied. In some cases, this may not be the household’s primary fuel source.  | 
		
152  | 
			NOTES: Include any notes below. Please indicate type of LIHEAP assistance and item being referenced.  | 
			NOTES: Include any notes below. Please indicate type of LIHEAP assistance and item being referenced.  | 
		
Popup instructions for Module 3 (Optional Measures)  | 
		||
Popup No.  | 
			Form Text over Hyperlink  | 
			URL or Popup Text  | 
		
153  | 
			Program Name:  | 
			If incorrect, click on the Grantee Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
154  | 
			Grantee Name:  | 
			If incorrect, click on the Grantee Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
155  | 
			Report Name:  | 
			If incorrect, click on the Grantee Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
156  | 
			Report Period:  | 
			If incorrect, click on the Report Selection link at the top of the page to return to a previous screen to make corrections or changes.  | 
		
157  | 
			Report Status:  | 
			Reports marked as ‘‘Saved with Warning’’ or ‘‘Saved and Validated’’ may be processed, but those marked as ‘‘Saved with Errors’’ need corrective action.  | 
		
158  | 
			Section Status:  | 
			Indication of each section’s status within the OLDC system.  | 
		
159  | 
			Initialized  | 
			Status Definition: Initialized - A new report form has been created but has not yet been saved.  | 
		
160  | 
			Edit-Saved  | 
			Status Definition: Edit - Saved. The Report Form will display one of three status. 1. Saved. The report form is saved. 2. Saved -- with Errors. The report form is saved and validated but there are errors on the saved form. The errors must be corrected and Validated again. 3. Saved -- with Warnings: The report form is saved and validated and there are some allowable errors on the saved form.  | 
		
161  | 
			Validated  | 
			Status Definition: Validated. The report form has been validated (i.e., calculations, required fields, and data accuracy are checked), and there are no errors on the saved form. The Form may now be Certified. The Report Status will be ‘‘Saved -- Validated’’.  | 
		
162  | 
			Certified  | 
			Status Definition: Certified. The Report Form will display one of two status. 1. Certified. The report form has been signed by an authorizing official but has not yet been submitted to ACF. 2. Certified -- with Warnings. The report form has been signed by an authorizing official but has not yet been submitted to ACF. Also, the report form is saved and validated (i.e., calculations, required fields, and data accuracy were checked), and there are some errors on the saved form. However, these errors are allowable by ACF and the report may still be submitted.  | 
		
163  | 
			Submitted  | 
			Status Definition: Submitted. The report form has been certified (signed) and sent to ACF or Submitted with Warnings: The report form has been certified (signed) and sent with warnings that are allowable by ACF.  | 
		
164  | 
			In Review  | 
			Status Definition: In Review. Regional or Central Office is reviewing the report and can no longer be edited by the grantee.  | 
		
165  | 
			C/O Approved  | 
			Status Definition: C/O Approved. The report form has been accepted by the Central Office and is no longer editable by the grantee.  | 
		
166  | 
			Grantee Name  | 
			Grantee Name  | 
		
167  | 
			Date  | 
			Date  | 
		
168  | 
			Telephone Number  | 
			Telephone Number  | 
		
169  | 
			Contact Person  | 
			Contact Person  | 
		
170  | 
			Email Address  | 
			Email Address  | 
		
171  | 
			V. ENERGY BURDEN TARGETING (OPTIONAL MEASURES)  | 
			
				This section contains optional data elements.  Optional data
				submitted by grantees will be used for more detailed analysis of
				energy burden reduction.  | 
		
172  | 
			Bill Payment- Assisted Household Main Heating Fuel  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
173  | 
			A. All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
174  | 
			All Households  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
175  | 
			Electricity  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
176  | 
			Natural Gas  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
177  | 
			Fuel Oil  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
178  | 
			Propane  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
179  | 
			Other Fuels  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
180  | 
			1. Average Annual Electricity Usage  | 
			Average Annual Electricity Usage: Line A1 allows grantees to report average annual electricity usage for bill-payment assisted households. This data will be used for more detailed analysis of home energy burden reduction.  | 
		
181  | 
			2. Average Annual Main Heating Usage  | 
			Average Annual Main Heating Usage: Line A2 allows grantees to report average annual main heating fuel usage for bill-payment assisted households. This data will be used for more detailed analysis of home energy burden reduction.  | 
		
182  | 
			B. High Burden Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
183  | 
			1. Average Annual Electricity Usage for High Burden  | 
			Average Annual Electricity Usage among High Burden Households: Line B1 allows grantees to report average annual electricity usage for high burden households. This data will be used for more detailed analysis of home energy burden reduction.  | 
		
184  | 
			2. Main Heating Usage for High Burden  | 
			Average Annual Main Heating Usage among High Burden Households: Line B2 allows grantees to report average annual main heating fuel usage for high burden households. This data will be used for more detailed analysis of home energy burden reduction.  | 
		
185  | 
			C. Unduplicated Number of LIHEAP Bill Payment-Assisted Households that Use:  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
186  | 
			1. Electricity as Supplemental Heating Fuel  | 
			Electricity as Supplemental Heating Fuel: Line C1 includes the unduplicated number of LIHEAP bill payment-assisted households that use electricity as a supplemental heating fuel. Grantees should report this data for all households, as well as for households within each main heating fuel type.  | 
		
187  | 
			2. Wood as Supplemental Heating Fuel  | 
			Wood as Supplemental Heating Fuel: Line C2 includes the unduplicated number of LIHEAP bill payment-assisted households that use wood as a supplemental heating fuel. Grantees should report this data for all households, as well as for households within each main heating fuel type.  | 
		
188  | 
			3. Other Supplemental Heating Fuel  | 
			Other Supplemental Heating Fuel: Line C3 includes the unduplicated number of LIHEAP bill payment-assisted households that use fuels other than electricity and wood for supplemental heating fuel. Grantees should report this data for all households, as well as for households within each main heating fuel type.  | 
		
189  | 
			4. Central Air Conditioning  | 
			Central Air Conditioning: Line C4 includes the unduplicated number of LIHEAP bill payment-assisted households with central air conditioning. Grantees should report this data for all households, as well as for households within each main heating fuel type.  | 
		
190  | 
			5. Window/Wall A/C (including evaporative cooler)  | 
			Window/Wall Air Conditioner: Line C5 includes the unduplicated number of LIHEAP bill payment-assisted households with Window/Wall AC (including evaporative coolers). (Note: If a household was already counted as having Central Air Conditioning, they should not be included here.) Grantees should report this data for all households, as well as for households within each main heating fuel type.  | 
		
191  | 
			VI. RESTORATION OF HOME ENERGY SERVICE (OPTIONAL MEASURES)  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
192  | 
			Energy Source  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
193  | 
			A. Number of All LIHEAP-Assisted Households that Had:  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
194  | 
			All Households  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
195  | 
			Electricity  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
196  | 
			Natural Gas  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
197  | 
			Fuel Oil  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
198  | 
			Propane  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
199  | 
			Other Fuels  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
200  | 
			Unduplicated Count of Restorations of Home Energy Service  | 
			Number of All LIHEAP Assisted Households that had Energy Service Restored: Line A allows grantees to report on the unduplicated number of households for which LIHEAP assistance led to the restoration of energy service. Households that had home energy service(s) reconnected with LIHEAP funds more than one time in FFY 2015 should only be counted once. (Note: Households for whom the primary energy service was restored should be counted even if they were able to heat or cool their home in another way).  | 
		
201  | 
			VII. PREVENTION OF LOSS OF HOME ENERGY SERVICE (OPTIONAL MEASURES)  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
202  | 
			Energy Source  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
203  | 
			A. Number of All LIHEAP-Assisted Households that Had:  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
204  | 
			All Households  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
205  | 
			Electricity  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
206  | 
			Natural Gas  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
207  | 
			Fuel Oil  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
208  | 
			Propane  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
209  | 
			Other Fuels  | 
			This section contains optional data elements. Optional data submitted by grantees will be used for more detailed analysis of energy burden reduction.  | 
		
210  | 
			Unduplicated Count of Preventions of Loss of Home Energy Service  | 
			Number of All LIHEAP Assisted Households where Receipt of LIHEAP Benefits Resulted in Continuance of Home Energy Service: Line A allows grantees to report on the unduplicated number households where receipt of LIHEAP benefit(s) resulted in continuance of home energy service. Households where loss of home energy service was prevented more than one time in FFY 2015 should only be counted once. Households who are already disconnected should not be counted in this section.  | 
		
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | Edelman, Peter (ACF) | 
| File Modified | 0000-00-00 | 
| File Created | 2021-12-17 |