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LIHEAP Performance Data
ICR 202112-0970-006 · OMB 0970-0449 · Object 117175701.
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| File Type | application/octet-stream |
|---|---|
| File Title | LIHEAP Performance Data |
| Author | Chris Hale |
| Last Modified By | Calc |
| File Modified | 2021-12-06 |
| File Created | 2026-08-12 |
| Conversion State | complete |
Extracted Text
OMB Control No. 0970-0449 OMB Control No. 0970-0449 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2021 Expiration Date: 03/31/21 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 2021. 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) 2021, the period of October 1, 2020 - September 30, 2021. 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. 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 Timely response 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 2021 10/1/2020 TO 9/30/2021) Amount Rounded to the Nearest Dollar A. All Funds Except CARES Act and other Supplemental Funding (Items 1-9) 1. FFY LIHEAP Block Grant Allotment (Net of Indian Tribal Set-Asides)--regular funds $0 2. FFY Emergency Contingency Funds (Net of Indian Tribal Set-Asides) $0 3. LIHEAP Block Grant Funds from Previous FFY Reallotted to FFY $0 4. Previous FFY Unobligated Emergency Contingency Funds, not Subject to 10% Carryover Limit $0 5. All Funds Carried Over From Previous FFY (except Funds in item 4 and 9 in this Section) $0 6. Petroleum Violation Escrow (Oil Overcharge) Funds Obligated in FFY $0 7. FFY Residential Energy Assistance Challenge (REACH) Program $0 8. Previous FFY REACH Program award obligated in FFY $0 9. FFY Leveraging Incentive Award $0 10. Previous FFY Leveraging Incentive Award obligated in FFY $0 B. Estimated Subtotal Sources of Funds--Non-CARES/Supplemental Funding 11. Sum of Items 1-10. This should equal the sum in Section IV. Column D, Item 13. $0 C. All Supplemental Funds (Items 12-14) 12. Previous unobligated CARES Act Allotment, not Subject to 10% Carryover Limit. This should equal the sum in Section IV Column D, Item 23. $0 13. American Rescue Plan Act Allotment (Net of Indian Tribal Set-Asides). This should equal the sum in Section IV Column D, Item 33. $0 14. [RESERVED, if applicable] Other Supplemental2 Allotment (Net of Indian Tribal Set-Asides). This should equal the sum in Section IV. Column D, Item 43. $0 D. Estimated Subtotal Sources of Supplemental Funds 15. Sum of Items 12-14. This should equal the sum in Section IV. Column D, Item 44. $0 E. Estimated Total of Sources of All Funds 16. Item 11 plus Item 15. This should equal the sum in Section IV. Column D, Item 45. [source.xlsx]Module 1 (Grantee Survey)! $0 1 of 22 OMB Control No. 0970-0449 OMB Control No. 0970-0449 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2021 Expiration Date: 03/31/21 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 2021. 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) 2021, the period of October 1, 2020 - September 30, 2021. 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. 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 Timely response 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 IV. ESTIMATED USES OF LIHEAP FUNDS A. Type of LIHEAP Assistance--Non-Supplemental Funds (Items 1-4) All of FFY 2021 (10/1/2020) to 9/30/2021) Amount Rounded to the Nearest Dollar Total Funds/Awards Average Household Maximum Annual Dollar Income for 4-Person Benefit Household as of the effective date 1. Heating Assistance Benefits--non-supplemental funds $0 $0 $0 2. Cooling Assistance Benefits--non-supplemental funds $0 $0 $0 3. Crisis Benefits by Type--non-supplemental funds a. Winter Crisis Benefits--non-supplemental funds b. Summer Crisis Benefits--non-supplemental funds c. Year-round Crisis Benefits--non-supplemental funds d. Other Crisis Benefits--non-supplemental funds (1) Specify--non-supplemental funds (2) Specify--non-supplemental funds (3) Specify--non-supplemental funds $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 4. Weatherization Assistance Benefits--non-supplemental funds $0 $0 B. Other Permitted Uses of LIHEAP Funds--non-supplemental funds (Items 5-12) 5. Nominal Payments--non-supplemental funds $0 6. FFY Unobligated Funds (excluding funds in Items 8 & 9) Carried Over to next FFY--non-supplemental funds $0 7. FFY Allowable Unobligated Emergency Contingency Funds, not Subject to 10% Carryover Limit, Obligated in next FFY $0 8. FFY Leveraging Incentive Award Obligated in next FFY $0 9. FFY LIHEAP Block Grant Allotment Used to Identify, Develop & Demonstrate Leveraging Incentive Activities--non-supplemental funds $0 10. Assurance 16 Activities--non-supplemental funds $0 11. FFY Residential Energy Assistance Challenge (REACH) Program $0 12. Administration/Planning Costs--non-supplemental funds $0 C. Estimated Total Uses of Funds--non-supplemental funds 13. Sum of Items 1-4 and 5-12. This should equal the sum in Section III. Column D, Item 11. $0 Q1. Obligated funding for a given type of assistance in current FFY, but will serve households in the subsequent FFY--regular funds -Select- Q2. Average Household Benefits are estimated due to unique program operation, rather than directly calculated--regular funds -Select- D. Type of LIHEAP Assistance--CARES Act Funds (Items 14-17) All of FFY 2021 (10/1/2020) to 9/30/2021) Amount Rounded to the Nearest Dollar Total Funds/Awards Average Household Maximum Annual Dollar Income for 4-Person Benefit Household as of the effective date 14. Heating Assistance Benefits--CARES Act Funds $0 $0 $0 15. Cooling Assistance Benefits--CARES Act Funds $0 $0 $0 16. Crisis Benefits by Type--CARES Act Funds a. Winter Crisis Benefits--CARES Act Funds b. Summer Crisis Benefits--CARES Act Funds c. Year-round Crisis Benefits--CARES Act Funds d. Other Crisis Benefits--CARES Act Funds (1) Specify--CARES Act Funds (2) Specify--CARES Act Funds (3) Specify--CARES Act Funds $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 [source.xlsx]Module 1 (Grantee Survey)! 2 of 22 OMB Control No. 0970-0449 OMB Control No. 0970-0449 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2021 Expiration Date: 03/31/21 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 2021. 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) 2021, the period of October 1, 2020 - September 30, 2021. 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. 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 Timely response 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. 17. Weatherization Assistance Benefits--CARES Act Funds $0 $0 E. Other Permitted Uses of LIHEAP Funds--CARES Act Funds (Items 18-22) 18. Nominal Payments--CARES Act Funds $0 19. Unobligated CARES Act Funds Carried Over to next FFY $0 20. FFY LIHEAP Block Grant Allotment Used to Identify, Develop & Demonstrate Leveraging Incentive Activities--CARES Act Funds $0 21. Assurance 16 Activities--CARES Act Funds $0 22. Administration/Planning Costs--CARES Act Funds $0 F. Estimated Total Uses of Funds--CARES Act Funds 23. Sum of Items 14-17 and 18-22. This should equal the sum in Section III. Column D, Item 12. $0 Q3. Obligated funding for a given type of assistance in current FFY, but will serve households in the subsequent FFY--CARES Act Funds -Select- Q4 Average Household Benefits are estimated due to unique program operation, rather than directly calculated--CARES Act Funds -Select- [source.xlsx]Module 1 (Grantee Survey)! 3 of 22 OMB Control No. 0970-0449 LIHEAP Performance Data Fo M A. Unduplicated Number of LIHEAP Bill Payment-Assisted Households B. 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) 2. Average Annual Household Income 3. Average Annual Total LIHEAP Benefit per Household (including Heating, Cooling, Crisis, Supplemental Ben 4. Average Annual Main Heating Fuel Bill 5. Average Annual Electricity Bill 6. Average Annual Total Residential Energy Bill 7. Average Annual Burden Before Receiving LIHEAP 8. Average Annual Burden After Receiving LIHEAP 9. Average Percentage Point Change in Energy Burden 10. Average Percentage Reduction in Energy Burden 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 (M 2. Average Annual Household Income for High Burden Households 3. Average Annual Total LIHEAP Benefit per High Burden Household (including Heating, Cooling, Crisis, Supp 4. Average Annual Main Heating Fuel Bill for High Burden Households 5. Average Annual Electricity Bill for High Burden Households 6. Average Annual Total Residential Energy Bill for High Burden Households 7. Average Annual Burden Before Receiving LIHEAP for High Burden Households 8. Average Annual Burden After Receiving LIHEAP for High Burden Households 9. Average Percentage Point Change in Energy Burden for High Burden Households 10. Average Percentage Reduction in Energy Burden for High Burden Households D. Benefit Targeting Index for High Burden Households: E. Burden Reduction Targeting Index for High Burden Households: A. All Occurrences of LIHEAP Households that Had: 1. Energy Service Restored After Disconnection 2. Fuel Delivered to Home that Ran Out of Fuel 3. Repair/Replacement of Inoperable Home Energy Equipment A. All Occurrences of LIHEAP Households that Had: 1. Past Due Notice or Utility Disconnect Notice 2. Imminent Risk of Running out of Fuel 3. Repair/Replacement of Operable Equipment to Prevent Imminent Home Energy Loss 2021 ormance Measures) Expiration Date: XX/XX/XX GETING Bill Payment-Assisted Household Main Fuel All Households Electricity Natural Gas Fuel Oil Auto-Calculated 0 0 0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated ERGY SERVICE Energy Source (where LIHEAP benefit was applied) All Occurrences Auto-Calculated Auto-Calculated Auto-Calculated Electricity 0 0 Natural Gas 0 0 Fuel Oil 0 0 ENERGY SERVICE Energy Source (where LIHEAP benefit was applied) All Occurrences Auto-Calculated Auto-Calculated Auto-Calculated Electricity 0 0 Natural Gas 0 0 Fuel Oil 0 0 Household Main Fuel Propane Other Fuels 0 0 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated EAP benefit was applied) Propane Other Fuels 0 0 0 0 EAP benefit was applied) Propane Other Fuels 0 0 0 0 OMB Control No. 0970-0449 LIHEAP Performance Data Fo A. Unduplicated Number of Household that Received Supplemental CARES Assistance, Alone o B. 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) 2. Average Annual Household Income 3. Average Annual Total CARES Benefit per Household (excluding benefit from regular funds or ARP) 4. Average Annual Main Heating Fuel Bill 5. Average Annual Electricity Bill 6. Average Annual Total Residential Energy Bill 7. Average Annual Burden Before Receiving LIHEAP 8. Average Annual Burden After Receiving LIHEAP 9. Average Percentage Point Change in Energy Burden 10. Average Percentage Reduction in Energy Burden 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 (M 2. Average Annual Household Income for High Burden Households 3. Average Annual Total CARES Benefit per High Burden Household (excluding benefit from regular funds or 4. Average Annual Main Heating Fuel Bill for High Burden Households 5. Average Annual Electricity Bill for High Burden Households 6. Average Annual Total Residential Energy Bill for High Burden Households 7. Average Annual Burden Before Receiving LIHEAP for High Burden Households 8. Average Annual Burden After Receiving LIHEAP for High Burden Households 9. Average Percentage Point Change in Energy Burden for High Burden Households 10. Average Percentage Reduction in Energy Burden for High Burden Households D. Benefit Targeting Index for High Burden Households: E. Burden Reduction Targeting Index for High Burden Households: A. All Occurrences of LIHEAP Households that Had: 1. Energy Service Restored After Disconnection because of CARES funds, alone or in combination with other 2. Fuel Delivered to Home that Ran Out of Fuel because of CARES funds, alone or in combination with other 3. Repair/Replacement of Inoperable Home Energy Equipment using CARES, alone or in combination with ot A. All Occurrences of LIHEAP Households that Had: 1. Past Due Notice or Utility Disconnect Notice & CARES Assistance, alone or in combination with other sour 2. Imminent Risk of Running out of Fuel & CARES LIHEAP Assistance Prevented Loss, alone or in combination 3. Repair/Replacement of Operable Equipment using CARES, alone or in combination with other sources, to Expiration Date: XX/XX/XX mance Measures) TING Bill Payment-Assisted Household Main Fuel All Households Electricity Natural Gas Fuel Oil Auto-Calculated 0 0 0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Y SERVICE Energy Source (where LIHEAP benefit was applied) All Occurrences Auto-Calculated Auto-Calculated Auto-Calculated Electricity 0 0 Natural Gas 0 0 Fuel Oil 0 0 ERGY SERVICE Energy Source (where LIHEAP benefit was applied) All Occurrences Auto-Calculated Auto-Calculated Auto-Calculated Electricity 0 0 Natural Gas 0 0 Fuel Oil 0 0 Household Main Fuel Propane Other Fuels 0 0 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated EAP benefit was applied) Propane Other Fuels 0 0 0 0 EAP benefit was applied) Propane Other Fuels 0 0 0 0 OMB Control No. 0970-0449 LIHEAP Performance Data Fo A. Unduplicated Number of Household that Received Supplemental ARPA Assistance, Alone o B. 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) 2. Average Annual Household Income 3. Average Annual Total ARPA Benefit per Household (excluding benefit from regular funds or CARES) 4. Average Annual Main Heating Fuel Bill 5. Average Annual Electricity Bill 6. Average Annual Total Residential Energy Bill 7. Average Annual Burden Before Receiving LIHEAP 8. Average Annual Burden After Receiving LIHEAP 9. Average Percentage Point Change in Energy Burden 10. Average Percentage Reduction in Energy Burden 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 (M 2. Average Annual Household Income for High Burden Households 3. Average Annual Total ARPA Benefit per High Burden Household (excluding benefit from regular funds or 4. Average Annual Main Heating Fuel Bill for High Burden Households 5. Average Annual Electricity Bill for High Burden Households 6. Average Annual Total Residential Energy Bill for High Burden Households 7. Average Annual Burden Before Receiving LIHEAP for High Burden Households 8. Average Annual Burden After Receiving LIHEAP for High Burden Households 9. Average Percentage Point Change in Energy Burden for High Burden Households 10. Average Percentage Reduction in Energy Burden for High Burden Households D. Benefit Targeting Index for High Burden Households: E. Burden Reduction Targeting Index for High Burden Households: A. All Occurrences of LIHEAP Households that Had: 1. Energy Service Restored After Disconnection because of ARPA funds, alone or in combination with other s 2. Fuel Delivered to Home that Ran Out of Fuel because of ARPA funds, alone or in combination with other s 3. Repair/Replacement of Inoperable Home Energy Equipment using ARPA, alone or in combination with oth A. All Occurrences of LIHEAP Households that Had: 1. Past Due Notice or Utility Disconnect Notice & ARPA Assistance, alone or in combination with other sourc 2. Imminent Risk of Running out of Fuel & ARPA LIHEAP Assistance Prevented Loss, alone or in combination 3. Repair/Replacement of Operable Equipment using ARPA, alone or in combination with other sources, to P Expiration Date: XX/XX/XX mance Measures) ING Bill Payment-Assisted Household Main Fuel All Households Electricity Natural Gas Fuel Oil Auto-Calculated 0 0 0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Y SERVICE Energy Source (where LIHEAP benefit was applied) All Occurrences Auto-Calculated Auto-Calculated Auto-Calculated Electricity 0 0 Natural Gas 0 0 Fuel Oil 0 0 ERGY SERVICE Energy Source (where LIHEAP benefit was applied) All Occurrences Auto-Calculated Auto-Calculated Auto-Calculated Electricity 0 0 Natural Gas 0 0 Fuel Oil 0 0 Household Main Fuel Propane Other Fuels 0 0 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 $0 $0 $0 $0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated EAP benefit was applied) Propane Other Fuels 0 0 0 0 EAP benefit was applied) Propane Other Fuels 0 0 0 0 OMB Control No. 0970-0449 OMB Control No. 0970-0449 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2020 Expiration Date: 03/31/21 LIHEAP Performance Data Form for Federal Fiscal Year (FFY) 2021 LIHEAP Performance Measures Expiration Date: XX/XX/XX Module 3. (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) 1. Average Annual Electricity Usage 2. Average Annual Main Heating Usage All Households Auto-Calculated Auto-Calculated Electricity 0 0 Natural Gas 0 0 Fuel Oil 0 0 Propane 0 0 Other Fuels 0 Auto-Calculated Auto-Calculated 0 0 0 0 0 0 0 0 0 Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated Auto-Calculated 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Propane 0 Other Fuels 0 Propane 0 Other Fuels 0 B. High Burden Households with 12 Consecutive Months of Bill Data (Main Fuel and Electric) 1. Average Annual Electricity Usage for High Burden 2. Main Heating Usage for High Burden C. Unduplicated Number of LIHEAP Bill Payment-Assisted Households that Use: 1. Electricity as Supplemental Heating Fuel 2. Wood as Supplemental Heating Fuel 3. Other Supplemental Heating Fuel 4. Central Air Conditioning 5. Window/Wall A/C (including evaporative cooler) VI. RESTORATION OF HOME ENERGY SERVICE (OPTIONAL MEASURES) Energy Source A. Number of All LIHEAP-Assisted Households that Had: Unduplicated Count of Restorations of Home Energy Service All Households Auto-Calculated Electricity 0 Natural Gas 0 Fuel Oil 0 VII. PREVENTION OF LOSS OF HOME ENERGY SERVICE (OPTIONAL MEASURES) Energy Source A. Number of All LIHEAP-Assisted Households that Had: Unduplicated Count of Preventions of Loss of Home Energy Service All Households Auto-Calculated Electricity 0 Natural Gas 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: 3A. Signature of Authorized Certifying Official: (click to sign) [source.xlsx]Module 3 (Optional Measures)! Fuel Oil 0 Date Submitted: Month Day Year 22 of 22