Utility Billing Recipient Cover

OMB Control Number 1910-XXXX

Recipient of Recovery Act funding,

You have recently received or will be receiving funding for energy efficiency retrofits and energy conservation measures on your building. Your support in implementing these retrofits is essential to putting America on the path to a clean energy future. In support of that same objective, the Department of Energy is undertaking an effort to collect and analyze energy consumption data from Recovery Act recipients in order to assess the impact of Recovery Act programs.

The attached form authorizes the Department of Energy to collect detailed information about energy consumption in buildings retrofitted with Recovery Act funds via the Weatherization Assistance Program, State Energy Program, and Energy Efficiency and Conservation Block Grant Program. This monthly utility bill information, collected by quarter for a period 36 months before and 36 months after the retrofit, includes your monthly energy consumption, the dates your meter was read, what your energy costs were, and whether or not your service was active.

Analysis of this pre- and post-retrofit energy consumption data will be used to better understand energy savings attributable to these programs.

All of the information obtained from this form and from utilities will be protected and will remain confidential. You are not required to provide this information or sign this form. If you decide not to sign this form, it will not affect your eligibility for programs under the Office of Weatherization and Intergovernmental Programs.

Thank you for supporting America’s energy independence and transition to a clean energy economy.

Sincerely,

Cathy Zoi

Assistant Secretary

Energy Efficiency and Renewable Energy

U.S. Department of Energy