Form DOE F 540.1 DOE F 540.1 State Energy Program Narrative Information Worksheet

DOE F 540.1
(08/05)

U.S. Department of Energy
STATE ENERGY PROGRAM (SEP)
NARRATIVE INFORMATION WORKSHEET

OMB Control No. 1910-5126
Expiration Date: 6/30/08

Grant Number: __________________
1. Market (choose one):
❑ Buildings
❑ Electric Power and Renewable Energy

❑ Energy Education
❑ Industry

❑ Policy, Planning, and Energy Security
❑ Transportation

2. State: ________________________
3. Program Year: ________________ Date Start: ________________ Date End: ________________
4. Topics involved in the overall program market (choose all that apply):
❑ Agriculture
❑ Alternative fuels
❑ Appliance efficiency and standards
❑ Bioenergy and biobased products
❑ Biomass power
❑ Building America
❑ Carpools, vanpools, and ridesharing
❑ Clean Cities
❑ Climate change planning
❑ Combined heat and power
❑ Commercial buildings
❑ Curriculum development
❑ Demand reduction
❑ Distributed energy generation
❑ Energy and environment
❑ Energy building codes
❑ Energy consumption and price statistics
❑ Energy emergency planning
❑ ENERGY STAR

❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑

Federal, state, and local facilities
Federal Energy Management Program
Financing energy programs
Fuel cells
General energy efficiency for industry
Geothermal
Green power programs
Heavy vehicles and trucks
Home energy ratings
Hydrogen
Hydropower
Industrial processing
Industries of the future
Lighting**
Low-income weatherization
Manufacturing
Motors and other industrial systems
Performance contracting
Policy and energy legislation

❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑

Procurement of efficient products**
Public information
Rating and labeling
Rebuild America
Residential buildings
Right turn on red**
Schools
Solar power
State energy strategic plans
Telecommuting
Thermal**
Traffic signals
Transmission and infrastructure
reliability
Transportation alternatives
Waste management and recycling
Water systems
Wind energy

5. Estimated Annual Energy Savings: ________________________ MBtus
6. Description (executive summary of goals and objectives)*

7. Program Year Milestones*
Milestone

Planned
(Number)

1
2
3
4
8. Program Year Funds by Source*
a. SEP grant (all funds in the approved budget)

Market Budget Total
b. Leveraged funds anticipated (outside approved budget)

Planned
$
$
$
$
$

* Please use additional pages if more space is needed.
** Mandatory requirement

DOE F 540.1

OMB Control No. 1910-5126

(08/05)

Expiration Date: 6/30/08

OMB Burden Disclosure Statement
This data is being collected to administer the Department of Energy State Program. The data you supply will be used to
respond to congressional, budget and general public inquiries of the program.
Public reporting burden for this collection of information is estimated to average 2 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 the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Chief Information Officer, Records Management Division, IM-11,
Paperwork Reduction Act Project (1910-5126), U.S. Department of Energy, 19901 Germantown Road, Germantown, MD 20874
and to the Office of Management and Budget, OIRA, Paperwork Reduction Act Project (1910-5126), Washington, DC 20503.
The SEP Narrative consists of information on each SEP market, mandatory or optional, planned for the program year (PY),
submitted on the SEP Narrative Information Worksheet included in the Forms section (or facsimile). If there is no change in
the purpose and description of a continuing market, only the milestones and PY budget need be submitted in subsequent years.
A state plan can have more than one Market/SEP Narrative Information Worksheet.
The Market Information Worksheet requests the following information.
Item

Explanation

1

Market

Select from the list of valid SEP market areas.

2

State

Self-explanatory

3

Program Year/Date Start/Date End

Federal fiscal year of allocation/obligation. Start and end dates for the state’s
program year.

4

Topic

Select the list of valid SEP Topics that pertain to this SEP market area.

5

Estimated Annual Energy Savings

An estimate of the energy to be saved annually, direct and indirect, by implementing
this market wherever practicable. States are encouraged to provide meaningful data
and realistic estimated numbers for energy saved to assist DOE in developing national
budget justifications.

6

Description (executive summary
of goals and objectives)

A concise description of the market, including goals and objectives, with enough
specificity to allow DOE to determine that it meets program intent and includes no
prohibited measures [Regs 420.18]. If the state has this information on a website, that
would be an optimal source for this information. (Any descriptions submitted would be
published on the DOE SEP Internet website.)

7

Program Year Milestones

Countable products, services, measures with planned total for each.
Milestones should correlate to topics.

8

Program Year Funds by Source
a) SEP grant (all funds in the
approved budget

Total grant funds – DOE, state match, PVE etc. – budgeted for this market this
program year (PY)

b) Leveraged funds anticipated
(outside approved budget)

Leveraged funds anticipated this PY, by source, for this market. This information is
not required, however it helps DOE justify the SEP budget.