Form 1 LIHEAP Performance Data

LIHEAP Performance Measures

LIHEAP Performance Data Form FY17.xlsx

State Grantees Module 1

OMB: 0970-0449

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Overview

LIHEAP Grantee Survey
LIHEAP Performance Measures
LIHEAP PM OPTIONAL Measures


Sheet 1: LIHEAP Grantee Survey

OMB Control No. 0970-0449 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2017 Expiration Date: XX/XX/XX












MODULE 1 (LIHEAP Grantee Survey)

SECTION I. GRANTEE INFORMATION
Grantee Name: Date: Contact Person:

Phone Number:
SECTION II. REPORTING REQUIREMENTS







The 50 States and the District of Columbia are required to complete the LIHEAP Grantee Survey Section of the LIHEAP Performance Data Form in providing estimates of sources and uses of funds, average benefits, and the maximum income cutoff in dollars for a 4-person household as of 10/1/16 for each type of LIHEAP assistance provided in FFY 2017.

Additionally, the 50 states and the District of Columbia are required to complete the LIHEAP Performance Measurement Section of the LIHEAP Performance Data Form. This Federal Report provides data on three required LIHEAP Performance Measures for Federal Fiscal Year (FFY) 2017, the period of October 1, 2016 - September 30, 2017. The Report consists of the following sections: (1) Energy Burden Targeting, (2) Restoration of Home Energy Service, and (3) Prevention of Loss of Home Energy Service.
Timely response to questions on this report is mandatory. The information will be used to respond to Congressional inquiries, to calculate LIHEAP benefit targeting, and to provide Federal Fiscal Year data for the Department's annual LIHEAP Report to Congress that is required under Section 2610 of Public Law 967-35, as amended. The data are also used in measuring LIHEAP performance under the Government Performance and Results Act (GPRA) of 1993, as amended by the GPRA Modernization Act of 2010. As the reported data are aggregated, the information in this report is not considered to be confidential.







SECTION III. ESTIMATED SOURCES OF LIHEAP FUNDS

ALL OF FFY 2017 10/1/2016 TO 9/30/2017)



Amount Rounded to the Nearest Dollar


A. All funds Except Leveraging Incentive Awards (Items 1-8)












1. FFY LIHEAP Block Grant Allotment (Net of Indian Tribal Set-Asides)
Pre-populated & locked $0










2. FFY Emergency Contingency Funds (Net of Indian Tribal Set-Asides)
Pre-populated & locked $0










3. LIHEAP Block Grant Funds Realloted to FFY
Pre-populated & locked $0










4. Previous FFY Unobligated Emergency Contingency Funds, not Subject to 10% Carryover Limit
Pre-populated $0










5. Reserved












6. All Funds Carried Over From Previous FFY (except Funds in item 4 and 10 in this Section)
Pre-populated $0










7. Petroleum Violation Escrow (Oil Overcharge) Funds Obligated in FFY
$0










8. FFY Residential Energy Assistance Challenge (REACH) Program
Pre-populated & locked $0










B. Leveraging Incentive Award (Items 9-10)












9. FFY Leveraging Incentive Award
Pre-populated & locked $0










10. Previous FFY Leveraging Incentive Award obligated in FFY
Pre-populated $0










C. Estimated Total Sources of Funds (Items 1-10)












11. Sum of Items 1-10. This should equal the sum in Section IV. Column D, Item 13.
Calculated & locked $0










SECTION IV. ESTIMATED USES OF LIHEAP FUNDS







A. Type of LIHEAP Assistance (Items 1-4)
All of FFY 2017 (10/1/2016) to 9/30/2017)


Amount Rounded to the Nearest Dollar


Total Funds/Awards Average Household Benefit Maximum Annual Dollar Income for 4-Person Household as of 10/1/16







1. Heating Assistance Benefits
$0 $0 $0







2. Cooling Assistance Benefits
$0 $0 $0







3. Crisis Benefits by Type:





a. Winter Crisis Benefits
$0 $0 $0
b. Summer Crisis Benefits
$0 $0 $0
c. Year-round Crisis Benefits
$0 $0 $0
d. Other Crisis Benefits
Locked with formula that sums sub columns to the right $0


(1) Specify:
$0 $0 $0
(2) Specify:
$0 $0 $0
(3) Specify:
$0 $0 $0







4. Weatherization Assistance Benefits
$0
$0









Bill Payment-Assisted Household Main Fuel
All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric) All Households Electricity Natural Gas Fuel Oil Propane Other Fuels
5. Average Annual Total LIHEAP Benefit per Household (including Heating, Cooling, Crisis, Supplemental Benefits)












B. Other Permitted Uses of LIHEAP Funds (Items 6-14)












6. Nominal Payments
$0









7. FFY Unobligated Funds (excluding funds in Items 8 & 9) Carried Over to next FFY
Pre-populated $0









8. FFY Allowable Unobligated Emergency Contingency Funds, not Subject to 10% Carryover Limit, Obligated in next FFY
$0









9. FFY Leveraging Incentive Award Obligated in next FFY
$0









10. Reserved












11. FFY LIHEAP Block Grant Allotment Used to Identify, Develop & Demonstrate Leveraging Incentive Activities
$0









12. Assurance 16 Activities
$0









13. FFY Residential Energy Assistance Challenge (REACH) Program
$0









14. Administration/Planning Costs
$0









C. Estimated Total Uses of Funds (Items 1-4 and 6-14)
$0









15. Sum of Items 1-4 and 6-14. This should equal the sum in Section III. Column D, Item 11.
Locked with formula that adds up the column values $0









Q1. Obligated funding for a given type of assistance in current FFY, but will serve households in the subsequent FFY
yes/no









Q2. Average Household Benefits are estimated due to unique program operation, rather than directly calculated
yes/no









Notes: Include any notes. Please indicate type of LIHEAP assistance and item being referenced.

Sheet 2: LIHEAP Performance Measures








OMB Control No. 0970-0449 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2017 Expiration Date: XX/XX/XX





Module II (Required LIHEAP Performance Measures)







V. ENERGY BURDEN TARGETING









Bill Payment-Assisted Household Main Fuel

All Households Electricity Natural Gas Fuel Oil Propane Other Fuels
A. Unduplicated Number of LIHEAP Bill Payment-Assisted Households Auto-Calculated 0 0 0 0 0







B. All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)





1. Unduplicated Number of Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric) Auto-Calculated 0 0 0 0 0
2. Average Annual Household Income Auto-Calculated $0 $0 $0 $0 $0
3. Average Annual Total LIHEAP Benefit per Household (including Heating, Cooling, Crisis, Supplemental Benefits) Auto-Calculated $0 $0 $0 $0 $0
4. Average Annual Main Heating Fuel Bill Auto-Calculated $0 $0 $0 $0 $0
5. Average Annual Electricity Bill Auto-Calculated Average annual electricity bill for bill payment-assisted households using electric main heat are reported, in total, under average annual main heating fuel bill. Grantees should enter $0 here. $0 $0 $0 $0 $0
6. Average Annual Total Residential Energy Bill Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated
7. Average Annual Burden Before Receiving LIHEAP Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated
8. Average Annual Burden After Receiving LIHEAP Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated
9. Average Percentage Point Change in Energy Burden Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated
10. Average Percentage Reduction in Energy Burden Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated







C. High Burden Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)





1. Unduplicated Number of High Burden Households (Top 25%) with 12 Consecutive Months of Bill Data (Main Fuel and Electric) Auto-Calculated 0 0 0 0 0
2. Average Annual Household Income for High Burden Households Auto-Calculated $0 $0 $0 $0 $0
3. Average Annual Total LIHEAP Benefit per High Burden Household (including Heating, Cooling, Crisis, Supplemental Benefits) Auto-Calculated $0 $0 $0 $0 $0
4. Average Annual Main Heating Fuel Bill for High Burden Households Auto-Calculated $0 $0 $0 $0 $0
5. Average Annual Electricity Bill for High Burden Households Auto-Calculated Average annual electricity bill for bill payment-assisted households using electric main heat are reported, in total, under average annual main heating fuel bill. Grantees should enter $0 here. $0 $0 $0 $0 $0
6. Average Annual Total Residential Energy Bill for High Burden Households Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated
7. Average Annual Burden Before Receiving LIHEAP for High Burden Households Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated
8. Average Annual Burden After Receiving LIHEAP for High Burden Households Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated
9. Average Percentage Point Change in Energy Burden for High Burden Households Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated
10. Average Percentage Reduction in Energy Burden for High Burden Households Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated







D. Benefit Targeting Index for High Burden Households: Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated







E. Burden Reduction Targeting Index for High Burden Households: Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated







VI. RESTORATION OF HOME ENERGY SERVICE









Energy Source (where LIHEAP benefit was applied)
A. All Occurrences of LIHEAP Households that Had: All Occurrences Electricity Natural Gas Fuel Oil Propane Other Fuels
1. Energy Service Restored After Disconnection Auto-Calculated 0 0


2. Fuel Delivered to Home that Ran Out of Fuel Auto-Calculated

0 0 0
3. Repair/Replacement of Inoperable Home Energy Equipment Auto-Calculated 0 0 0 0 0







VII. PREVENTION OF LOSS OF HOME ENERGY SERVICE





Energy Source (where LIHEAP benefit was applied)
A. All Occurrences of LIHEAP Households that Had: All Occurrences Electricity Natural Gas Fuel Oil Propane Other Fuels
1. Past Due Notice or Utility Disconnect Notice Auto-Calculated 0 0


2. Imminent Risk of Running out of Fuel Auto-Calculated

0 0 0
3. Repair/Replacement of Operable Equipment to Prevent Imminent Home Energy Loss Auto-Calculated 0 0 0 0 0







NOTES: Include any notes.



VIII. CERTIFICATION FOR REQUIRED SECTIONS I. - VII.
1A. I certify to the best of my knowledge and belief that this report is correct and complete for Administration and Congressional oversight the program and for the purposes set forth in the award letter.
2A. Typed or Printed Name and Title of Authorized Certifying Official:


Date Submitted:
3A. Signature of Authorized Certifying Official: (click to sign)


Month Day Year








Sheet 3: LIHEAP PM OPTIONAL Measures








OMB Control No. 0970-0449 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2017 Expiration Date: XX/XX/XX





LIHEAP Performance Measures
Module III. (Optional LIHEAP Performance Measures)
V. ENERGY BURDEN TARGETING (OPTIONAL MEASURES)









Bill Payment-Assisted Household Main Fuel
A. All Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric) All Households Electricity Natural Gas Fuel Oil Propane Other Fuels
1. Average Annual Electricity Usage Auto-Calculated Average annual electricity usage for bill payment-assisted households using electric main heat are reported, in total, under average annual main heating fuel bill. This field is locked from editing in OLDC, but should be treated as zero usage, since electricity consumption by electric main heat households is counted as heating fuel usage. 0 0 0 0 0
2. Average Annual Main Heating Usage Auto-Calculated 0 0 0 0







B. High Burden Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric)





1. Average Annual Electricity Usage for High Burden Auto-Calculated Average annual electricity usage for bill payment-assisted high burden households using electric main heat are reported, in total, under average annual main heating fuel bill. This field is locked from editing in OLDC, but should be treated as zero usage, since electricity consumption by electric main heat households is counted as heating fuel usage. 0 0 0 0 0
2. Main Heating Usage for High Burden Auto-Calculated 0 0 0 0







C. Unduplicated Number of LIHEAP Bill Payment-Assisted Households that Use:





1. Electricity as Supplemental Heating Fuel Auto-Calculated
0 0 0 0
2. Wood as Supplemental Heating Fuel Auto-Calculated 0 0 0 0 0
3. Other Supplemental Heating Fuel Auto-Calculated 0 0 0 0 0
4. Central Air Conditioning Auto-Calculated 0 0 0 0 0
5. Window/Wall A/C (including evaporative cooler) Auto-Calculated 0 0 0 0 0







VI. RESTORATION OF HOME ENERGY SERVICE (OPTIONAL MEASURES)









Energy Source
A. Number of All LIHEAP-Assisted Households that Had: All Households Electricity Natural Gas Fuel Oil Propane Other Fuels
Unduplicated Count of Restorations of Home Energy Service Auto-Calculated 0 0 0 0 0







VII. PREVENTION OF LOSS OF HOME ENERGY SERVICE (OPTIONAL MEASURES)





Energy Source
A. Number of All LIHEAP-Assisted Households that Had: All Households Electricity Natural Gas Fuel Oil Propane Other Fuels
Unduplicated Count of Preventions of Loss of Home Energy Service Auto-Calculated 0 0 0 0 0







VIII. CERTIFICATION FOR OPTIONAL DATA
1A. I certify to the best of my knowledge and belief that this report is correct and complete for Administration and Congressional oversight the program and for the purposes set forth in the award letter.
2A. Typed or Printed Name and Title of Authorized Certifying Official:


Date Submitted:
3A. Signature of Authorized Certifying Official: (click to sign)


Month Day Year
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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