Form 1 Model Plan

8

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

MODEL PLAN

for the

Residential Energy Assistance Challenge Program (REACH)

FISCAL YEAR (FY) _______________

GRANTEE (STATE, TRIBE, TRIBAL ORGANIZATION OR INSULAR AREA):

__________________________________________________________________________

EIN:______________________________________________________________________

GRANTEE CONTACT NAME :_______________________________________________

ADDRESS:________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

EMAIL: ___________________________________________________________________

TELEPHONE: _____________________________FAX: ____________________________

July 2008

OMB Approval No. 0970-0348

Expiration Date: XX/XX/XXXX

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)

Public reporting burden for this collection of information is estimated to average 72 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

Residential Energy Assistance Challenge Program (REACH)

Part I - Signature

Certification to the REACH Assurances:

Section 2607B (e) (2) (A) through (M) of the LIHEAP Act – Elements of State Plans

(A) an assurance that such State will deliver services through community-based nonprofit entities in such State, by--

(i) awarding grants to, or entering into contracts with, such entities for the purpose of

providing such services and payments directly to individuals eligible for benefits; or

(ii) if a State makes payments directly to eligible individuals or energy suppliers,

making contracts with such entities to administer such programs, including

(I) determining eligibility;

(II) providing outreach services; and

(III) providing benefits other than payments;

(B) an assurance that, in awarding grants or entering into contracts to carry out its REACH initiative, the State will give priority to organizations that--

(i) are described in section 673 of the Community Services Block Grant Act (42 U.S.C.

9902(1)), except where significant geographic portions of the State are not served by such

entities;

(ii) the Secretary has determined have a record of successfully providing services under

the Low-Income Home Energy Assistance Program; and

(iii) receive weatherization assistance program funds under part A of title IV of the

Energy Conservation and Production Act (42 U.S.C. 6861 et seq.); except that a State may not

require any such entity to operate a REACH program;

(C) an assurance that, subject to subparagraph (D), each entity that receives a grant or enters into a contract under subparagraph (A)(i) will provide a variety of services and benefits, including—

(i) payments to, or on behalf of, individuals eligible for residential energy assistance

services and benefits under section 2605(b) for home energy costs;

(ii) energy efficiency education;

(iii) residential energy demand management services, including any other energy related residential repair and energy efficiency improvements in coordination with, or delivered by,

Department of Energy weatherization assistance programs at the discretion of the State;

(iv) family services, such as counseling and needs assessment, related to energy budget

management, payment plans, and related services; and

(v) negotiation with home energy suppliers on behalf of households eligible for REACH services and benefits;

(D) a description of the methodology the State and local agencies will use to determine—

(i) which households will receive one or more forms of benefits under the State

REACH initiative;

(ii) the cases in which nonmonetary benefits are likely to provide more cost-effective

long-term outcomes than payment benefits alone; and

(iii) the amount of such benefit[s] required to meet the goals of the program;

(E) a method for targeting nonmonetary benefits;

(F) a description of the crisis and emergency assistance activities the State will undertake that are designed to—

(i) discourage family energy crises;

(ii) encourage responsible vendor and consumer behavior; and

(iii) provide only financial incentives that encourage household payment;

(G) a description of the activities the State will undertake to—

(i) provide incentives for recipients of assistance to pay home energy costs; and

(ii) provide incentives for vendors to help reduce the energy burdens of recipients of

assistance;

(H) an assurance that the State will require each entity that receives a grant or enters into a contract under this section to solicit and be responsive to the views of individuals who are

financially eligible for benefits and services under this section in establishing its local program;

(I) a description of performance goals for the State REACH initiative including—

(i) a reduction in the energy costs of participating households over one or more fiscal

years;

(ii) an increase in the regularity of home energy bill payments by eligible households;

and

(iii) an increase in energy vendor contributions towards reducing energy burdens of eligible households;

(J) a description of the indicators that will be used by the State to measure whether the performance goals have been achieved;

(K) a demonstration that the plan is consistent with section 2603, paragraphs (2), (3), (4), (5), (7), (9), (10), (11), (12), (13), and (14) of section 2605(b), subsections (d), (e), (f), (g), (h), (i), and (j) of section 2605, and section 2606 of this title;

(L) an assurance that benefits and services will be provided in addition to other benefit payments and services provided under this title and in coordination with such benefit payments and services; and

(M) an assurance that no regulated utility covered by the plan will be required to act in a manner

that is inconsistent with applicable regulatory requirements.

Certification to the Assurances: As Chief Executive Officer, I agree to comply with the REACH assurances contained in Section 2607B(e), Title XXVI of the Omnibus Budget Reconciliation Act of l981, as amended. By signing these assurances, I also agree to abide by the standard assurances on lobbying, debarment and suspension, and a drug-free workplace.

Signature of the Tribal or Board Chairperson or Chief Executive Officer of the State or Territory*:

Signature___________________________________________________________________________

Title:______________________________________________________________________________

Date:______________________________________________________________________________

* If a person other than the Chief Executive Officer of the State or insular area, or Tribal Chairperson or Board Chairperson of a tribal organization, is signing the certification to the assurances, a letter must be submitted delegating such authority. (PLEASE ATTACH DELEGATION AUTHORITY.) The delegation must include authority to sign the assurances, not just to administer the program.

In the REACH assurances which are quoted from the law and cited above, "State" means the 50 States, the District of Columbia, an Indian Tribe or Tribal Organization, or an Insular Area; "title" of the Act refers to Title XXVI of the Omnibus Budget Reconciliation Act of 1981 (OBRA), as amended.

Tribes, Tribal Organizations, and Insular Areas except Puerto Rico are exempt from Assurances (A) and (B).

___________________________________________

Part II - Descriptions of REACH Assurances

(statutory

references)

(Assurances C

& F)

2607B(e)(2)(C)&(F) Describe services to be provided by the REACH plan including the health and safety activities you will implement to help households avoid crisis situations. This description should include the home energy-related health and safety needs to be addressed and the REACH activities that will be carried out to respond to those needs. This description shall not be more than 2 pages long.

For State Grantees and Puerto Rico, this description should clearly define the roles of the grantee and the community based organization(s).

(Assurance D)

2607B(e)(2)(D) How will you determine:

(a) Which households receive REACH benefits?

(b) Benefit amounts?

What non-monetary benefits will you provide?

(Assurance G)

2607B(e)(2)(G) What incentives will you develop and implement for households receiving REACH benefits? For vendors?

(Assurances I & J)

2607B(e)(2)(I) EVALUATION: What performance goals will you establish for your REACH program with outcomes to (a) increase the health and safety of vulnerable LIHEAP households; (b) reduce household energy costs?

Explain how data will be collected and analyzed.

2607B(e)(2)(J) What indicators will you use to measure whether your stated performance goals have achieved the desired outcomes (findings and conclusions)?

The combined description provided for I and J above shall not be longer than 1 page and may be attached. A Final Evaluation is due 6 months after the end of the grant period and should include EEES activities, if implemented. An independent evaluator is not required.

(Assurance H)

2607B(e)(2)(H) Describe how the views of low income households will be solicited with regard to the design of the program. Describe how the grantee will respond to those views.

(Assurances A&B)

2607B(e)(2)(A)&(B) FOR STATES AND PUERTO RICO ONLY: States and Puerto Rico shall provide REACH services through one or more community based non-profit organizations (CBOs). Provide the following for each CBO implementing REACH:

CBO Contact Name:

Organization:

Address:

Telephone Number:

Email:

Fax:

Part III – Funding Level Requested

Funding level requested for the REACH Plan is $____________________.

If the grantee chooses to provide an EEES plan, as described below in Part IV, funding level requested is $____________________.

Part IV Description of Energy Efficiency Education Services (EEES) - Optional

(statutory

references)

2607B(b)(2)(A)&(B)  If the grantee chooses to provide educational services that will provide knowledge to low income households concerning energy conservation, weatherization, energy efficient practices or appliances, health and safety factors involved in extreme weather conditions, or other similar energy educational services, provide the following:

• Description of the services to be provided and the needs addressed by those services;

• Description of the target population;

• Where and how services will be provided; and

• Who will provide EEES services.

The EEES plan description shall be no more than 1 page.

Reminders

Plan descriptions must be written in font size no less than 12 pt. Most descriptions should be no longer than one or two paragraphs except for the following:

The REACH plan description for Assurances C&F combined shall be limited to 2 pages or less.

The REACH plan description for Assurances I & J combined shall be limited to 1 page or less.

If you elect to provide an EEES plan, your description for Part IV shall be 1 page or less.