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DOE F 540.2		            OMB Control No. 1910-5127
	Expiration date: XX/XX/2023										U.S. Department of Energy								

	U.S. Department of Energy	
	WEATHERIZATION ANNUAL FILE WORKSHEET


Grant #:  __________   State:  ___________   Program Year:  __________

Budget Period: __________________

IV.1  Subgrantees

Grantee

City
Tentative


Funding*
Units*












Totals


*	Funding can include non-DOE sources if included in DOE budget.  Units can include those completed with non-DOE funding if included in the DOE budget.

IV.2  WAP Production Schedule
Number of Units (Excluding reweatherized)

Reweatherized Units


Average Unit Costs, including Reweatherization, Subject to DOE Program Rules*
   VEHICLES & EQUIPMENT AVERAGE COST PER DWELLING UNIT (DOE RULES)

A  Total Vehicles & Equipment ($5,000 or more) Budget

B  Total Units Weatherized

C  Total Units Reweatherized

D  Total Dwelling Units to be Weatherized and Reweatherized (B+C)

E  Average Vehicle & Equipment Acquisition Cost per Unit (A divided by D)

   AVERAGE COST PER DWELLING UNIT (DOE RULES*)

F  Total Funds for Program Operations**

G  Total Dwelling Units to be Weatherized and Reweatherized (from line D)

H  Average Program Operations Cost per Unit (F divided by G)

I   Average Vehicle & Equipment Acquisition Cost per Unit (from line E)

J   Total Average Cost per Dwelling (H plus I)

*	Funding can include non-DOE sources if included in DOE budget.  Units can include those completed with non-DOE funding if included in the DOE budget.
**	Funds for program operations include expenditures described by 440.18(c)(1) through (9).

IV.3  Energy Savings
Method used to calculate energy savings:  	WAP algorithm:  	   	Other (describe below):

Other Energy Savings Method Description







This year estimated energy savings (MBtus):  ________________
Prior year estimated energy savings (MBtus):  ________________       Actual: ­­­­________________


U.S. Department of Energy
WEATHERIZATION ANNUAL FILE WORKSHEET (continued)

Grant #:  __________   State:  ___________   Program Year:  __________

Budget Period: __________________


IV.4  DOE-Funded Leveraging Activities






IV.5  Policy Advisory Committee Members







IV.6  State Plan Hearings (Note: attach notes and transcript to the SF-424)
Hearing Date:
Newspapers that publicized the hearings and the dates that the notice ran.











IV.7  Miscellaneous








OMB Burden Disclosure Statement

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PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

 U.S. Department of Energy
WEATHERIZATION ASSISTANCE PROGRAM
ANNUAL FILE WORKSHEET
INSTRUCTIONS

The Annual File Worksheet is designed to gather specific detail related to the expenditures of the Weatherization grant.





Item

Explanation
IV.1 
Subgrantees

    • Grantee

    • City

    • Funding

    • Units


Identify each intended subgrantee by name

Identify the city in which the agency resides

Identify the tentative funding each agency will receive

Identify the tentative total of completed units anticipated by the agency with this funding


IV.2
Production Schedule

    • Total Units


    • Reweatherized Units


    • Average Unit Costs, including Reweatherization, Subject to DOE Program /Rules



Calculate the total units expected to be weatherized for this program year, excluding reweatherized units 

Calculate the number of reweatherized units to be completed this program year.

Enter data for and add and subtract, as specified to determine the average unit costs for units subject to DOE Program/Rules



IV.3   
Energy Savings

Identify whether the states will use the WAP Algorithm or Other method to calculate the estimated energy savings; if other method, description must be entered

Identify the actual estimated energy savings in MBtus attributed to this funding and program year

IV.4
DOE-Funded Leveraging Activities
State weatherization leveraging activities anticipated during this program year using DOE funding

IV.5
Policy Advisory Committee Members
Provide the names, groups, organizations, or agencies represented by the PAC members and a list of the PAC meeting(s) attendees

IV.6
State Plan Hearings 
Identify the hearing date(s); a list of the newspapers that publicized the hearings including the dates the notices ran (notes, minutes, or transcripts should attached to the SF-424)

IV.7
Miscellaneous
Identify any anticipated activities that are not routinely administered as part of the Weatherization Assistance Program (e.g., disaster relief, energy crisis response)