Quarterly Performance and Management Report for LIHWAP (FY 2023)

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OMB Control No. 0970-0578

Low Income Household Water Assistance Program Quarterly Perfo
Management Form
Recipient Information
Recipient Name:
Contact Name:
Contact Phone Number:
Contact Email:

First Quarterly Performance and Management Report (October 1- December 31
I. Total Households Assisted
A. Total Households
Q1
1. Unduplicated number of households assisted

II. Assistance Provided by Service Type

Number of assisted households by S
Type of LIHWAP assistance for households
1. Restoration of services

A. Water or
Wastewater
0

2. Prevention of disconnection of services

0

3. Reduction of rates charged

0

*If other services were paid for with LIHWAP funds, please explain
Response:

III. Performance Management

Describe up to three notable accomplishments achieved by LIHWAP during the implementation period, including any innovative approaches or policies that were put into pla
Please include a participant success story, if applicable.
Response:

2. Describe any challenges with LIHWAP implementation during the reporting period.
Response:

3. Are there additional unmet water or wastewater needs in your service area? If yes, please describe.
Response:

4. Do you have any training and/or technical assistance needs that you would like the Office of Community Services to offer support for?

Response:

IV. Use of Funds

Actual Obligated Funds
A. Consolidated
Appropriation Act,
2021 Funding
1. Funding obligated to date for the Fiscal Year

V. Remarks
1. Enter any explanation needed regarding the reliability and/or validity of the above-reported data.
Response:

VI. Certification

Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent informa
civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)
a. Name of Authorized Official:

b. Title of Authorized Official:

c. Signature of Authorized Official:

d. Date Signed:

X

Expiration Date: XXXXXX

ram Quarterly Performance and

n

ort (October 1- December 31)

Number of assisted households by Service Type
B. Multiple Water
Services
0

C. Other Water
Services
0

0

0

0

0

ative approaches or policies that were put into place during the reporting period.

r support for?

Actual Obligated Funds
B. American Rescue
Act, 2021 Funding

C. Reserve for
Possible Future

are that any false, fictitious, or fraudulent information may subject me to criminal,

OMB Control No. 0970-0578

Low Income Household Water Assistance Program Quarterly Perfo
Management Form
Recipient Information
Recipient Name:
Contact Name:
Contact Phone Number:
Contact Email:

Second Quarterly Performance and Management Report (January 1- March 31
I. Total Households Assisted
A. Total Households Q2
1. Unduplicated number of households assisted

II. Assistance Provided by Service Type

Number of assisted households b
Type of LIHWAP assistance for households

A. Water or Wastewater

1. Restoration of services

0

2. Prevention of disconnection of services

0

3. Reduction of rates charged

0

*If other services were paid with LIHWAP funds, please explain
Response:

III. Performance Management

1. Describe up to three notable accomplishments achieved by LIHWAP during the implementation period, including any innovative approaches or policies that were put into p
Please include a participant success story, if applicable.
Response:

2. Describe any challenges with LIHWAP implementation during the reporting period.
Response:

3. Are there additional unmet water and wastewater needs in your service area? If yes, please describe.
Response:

4. Do you have any training and/or technical assistance needs that you would like the Office of Community Services to offer support for?
Response:

IV. Use of Funds

Actual Obligated Fund
A. Consolidated
Appropriation Act, 2021
Funding
1. Funding obligated to date for the Fiscal Year

V. Remarks
1. Enter any explanation needed regarding the reliability and/or validity of the above-reported data.
Response:

VI. Certification

Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent informa
civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)
a. Name of Authorized Official:

b. Title of Authorized Official:

c. Signature of Authorized Official:

d. Date Signed:

X

Expiration Date: XXXXXX

am Quarterly Performance and

eport (January 1- March 31)
B Total Cumulative
Households

0
Number of assisted households by Service Type
B. Multiple Water
Services
0

C. Other Water
Services
0

0

0

0

0

tive approaches or policies that were put into place during the reporting period.

pport for?

Actual Obligated Funds
B. American Rescue
Act, 2021 Funding

C. Reserve for
Possible Future

that any false, fictitious, or fraudulent information may subject me to criminal,

Quarterly Q3
OMB Control
No. 0970-0578
Low Income
Household
Water
Assistance
Program
Quarterly
Performance
and
Management
Form

Expiration Date: XXXXXX

Page 11

OMB Control No. 0970-0578

Low Income Household Water Assistance Program Quarterly Perfo
Management Form
Recipient Information
Recipient Name:
Contact Name:
Contact Phone Number:
Contact Email:

Fourth Quarterly Performance and Management Report (July 1 - September 30
I. Total Households Assisted
A. Total Households Q4
1. Unduplicated number of households assisted

II. Assistance Provided by Service Type

Number of assisted households by
Type of LIHWAP assistance for households
1. Restoration of services

A. Water or
Wastewater
0

2. Prevention of disconnection of services

0

3. Reduction of rates charged

0

*If other services were paid with LIHWAP funds, please explain
Response:

III. Performance Management

1. Describe up to three notable accomplishments achieved by LIHWAP during the implementation period, including any innovative approaches or policies that were put into p
Please include a participant success story, if applicable.
Response:

2. Describe any challenges with LIHWAP implementation during the reporting period.
Response:

3. Are there additional unmet water and wastewater needs in your service area? If yes, please describe.
Response:

4. Do you have any training and/or technical assistance needs that you would like the Office of Community Services to offer support for?
Response:

5. Please list and describe up to three lessons learned during the first year of LIHWAP implementation.

Response:

IV. Use of Funds

Actual Obligated Fund
A. Consolidated
Appropriation Act, 2021
Funding
1. Funding obligated to date for the Fiscal Year

V. Remarks
1. Enter any explanation needed regarding the reliability and/or validity of the above-reported data.
Response:

VI. Certification

Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent informa
civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)
a. Name of Authorized Official:

b. Title of Authorized Official:

c. Signature of Authorized Official:

X
d. Date Signed:

Expiration Date: XXXXXX

ram Quarterly Performance and

eport (July 1 - September 30)
B. Total Cumulative
Households

0
Number of assisted households by Service Type
B. Multiple Water
Services
0

C. Other Water
Services
0

0

0

0

0

vative approaches or policies that were put into place during the reporting period.

support for?

Actual Obligated Funds
B. American Rescue
Act, 2021 Funding

C. Reserve for
Possible Future

e that any false, fictitious, or fraudulent information may subject me to criminal,