Weatherization Assistance Program Evaluation

OMB Control Number: _ _ _ _ - _ _ _ _

Metered Fuels and Air Conditioning Studies

This data is being collected to choose a sample of homes to conduct detailed technical studies of the results of weatherization.  The data you supply will be used to build the sampling frame.

Public reporting burden for this collection of information is estimated to average sixteen hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records Management Division, IM-11, Paperwork Reduction Project (1910-XXXX), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (1910-XXXX), Washington, DC  20503.

All of the information obtained from this survey will be protected and will remain confidential. The data will be analyzed in such a way that the information provided cannot be associated back to your state, your agencies, or the housing units and clients that your state served.

Instructions --

As part of the national evaluation of the Weatherization Assistance Program, the space-heating energy consumption of a sample of housing units heated by fuel oil or propane will be submetered to determine the energy savings achieved by the Program. In addition, the air-conditioning electricity consumption of a sample of housing units will be submetered. We would like to submeter a number of such housing units served by your agency.

To help us randomly select a sample of housing units, please use the first attached form to provide us with the job numbers for all the housing units that you currently have scheduled to be weatherized or that are on your waiting list. In addition to the job number, please identify the status (scheduled for weatherization or on waiting list), building type, if the unit is heated primarily by fuel oil or propane, and the type of air conditioning unit. Once we have made an initial selection of housing units from your agency, we will contact you to get contact information on those clients using the second attached form so that we can obtain their agreement to participate in the submetering project.

Housing Units Scheduled for Weatherization or On Your Waiting List

Agency name: _______________________________

State: ______________________________________

Date: ______________________________________

Please provide the following information for all the housing units currently scheduled to be weatherized by your agency or that are on your agency’s waiting list:

Job Number	Status (W – scheduled for weatherization, WL – waiting list)	Building Type (SF – single family, MH – mobile home, SMF – small multifamily, MF – multifamily)	Primary Heating Fuel (FO – fuel oil, P – propane, O – other)	Air Conditioner Type (C – central, W – window or room, E – evaporative cooler, N – none)

Contact Information on Selected Clients

Agency name: _______________________________

State: ______________________________________

Date: ______________________________________

Please provide the following information for all the housing units whose job numbers are listed in the first column:

Job Number	Name	Address	City	State	Zip Code	Phone Number	Scheduled Weatherization Date

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