Attachment
B
OMB
Clearance No.: 0970-0106
Expiration
Date:
m/dd/yyyy
LOW
INCOME
HOME
ENERGY
ASSISTANCE
PROGRAM
CARRYOVER
AND
REALLOTMENT
REPORT
|
Grant
Recipient:
|
Date:
|
SECTION
1:
For
Annual LIHEAP
Block
Grant
Funds,
Including Regular Federal Fiscal Year (FFY) [FY] Funds
Appropriated
through
the Annual Appropriations Cycle and FFY [FY] Supplemental Funds
Appropriated
through
the Infrastructure Investment and Jobs Appropriations Act
(Infrastructure Act) [Public
Law
(Pub. L. 117-58)],
and for FFY [FY-1] Funds Reallotted for FFY [FY]
|
Section
2607(b)(2)(B) of the LIHEAP statute (42 U.S.C. 8626(b)(2)(B))
requires that, except where permitted otherwise, at least 90
percent of funds available
to you must
be obligated in the year in which they are appropriated. Not more
than 10 percent of this amount payable f
or
a
fiscal year may be held for obligation
in
the succeeding fiscal year.
|
1.1)
Current
year
amount
payable
(regular
block
grant
funds,
Infrastructure Act funds, and
reallotted
funds)
|
[OLDC_PREPOP]
|
1.2)
10
percent
of
amount
payable
(regular
block
grant
funds,
Infrastructure Act funds,
and
reallotted
funds)
|
[OLDC_AUTOCALC]
|
1.3)
Projected
unobligated
balance
(regular
block
grant
funds
and
reallotted
funds)
|
[RECIPIENT_ENTRY]
|
1.4)
Projected unobligated balance (Infrastructure Act funds only)
|
[RECIPIENT_ENTRY]
|
If
the sum of lines
1.3
and 1.4 is
equal
to
or
less
than
line
1.2
then,
on the following two lines, OLDC will show the
amount
from
lines
1.3
and 1.4 for
your
carryover
amount
and zero
for
your reallotment
amount.
If
the sum of lines
1.3
and 1.4 is
larger
than
line
1.2,
then,
on the following two lines, OLDC will show the
amount
on
line
1.2
as
your
carryover
amount
and the
difference
between
line
1.2
and
that
sum as
your
reallotment amount.
|
Regular
Block
Grant
Carryover
Amount
(Regular
block
grant
funds
plus Infrastructure Act funds and reallotted funds to
be
carried
over
for
obligation
in
the
following
fiscal
year.)
|
[OLDC_AUTOCALC]
|
Reallotment
Amount
(Regular
block
grant
funds
plus Infrastructure Act funds and reallotted funds that
exceed
the
10%
carryover
amount
and
are
to
be
returned
the
Federal
government.)
|
[OLDC_AUTOCALC]
|
If
OLDC
shows a
Regular
Block
Grant
Carryover
amount
under
line
1.4,
please
provide
the
following:
|
1.4)a)
Briefly
state
the
reasons
that
these
funds
will
not
be
obligated
in
the
fiscal
year
for
which
they
were
allotted [RECIPIENT_ENTRY]
|
1.4)b)
Briefly
describe
the
types
of
assistance
to
be
provided
with
the
amount
of
regular
block
grant
funds,
Infrastructure Act funds, and reallotted funds
that
will
be
held
available
for
the
following
fiscal
year:
[RECIPIENT_ENTRY]
|
SECTION
2:
For
FFY 2022 LIHEAP
Supplemental
Funds
Appropriated
through
the
American Rescue Plan Act of 2021 (ARPA)
(Pub. L. 117-2)
|
ARPA
(Pub. L. 117-2)
allows
grant
recipients
to
obligate
up
to
100
percent
of
LIHEAP
funds
in
Federal
Fiscal
Year
(F
FY)
2022.
|
2.1)
Amount
payable
(ARPA
funds
only)
|
[OLDC_PREPOP]
|
2.2)
Projected
unobligated
balance
(ARPA
funds
only)
|
[RECIPIENT_ENTRY]
|
2.3)
Projected
return
of
funds
to
HHS/unobligated
balance
as
of
9/30/2022
(ARPA
funds
only)
If
you
report
an
unobligated
ARPA
amount
on line
2.3,
then please
provide
the
following:
|
[OLDC_AUTOCALC]
|
2.3)a)
Briefly describe the types of assistance to be provided with the
ARPA funds held available for FFY 2023: [BLANK_FROZEN]
|
2.3)b)
Briefly
state
the
reasons
that
these
ARPA funds
will
not
be
obligated
in FFY 2022: [RECIPIENT_ENTRY]
|
SECTION
3:
For
FFY [FY] LIHEAP
Supplemental
Funds
Appropriated
through
the
[ACT_NAME]
(Pub. L.
[PLNO])
|
The
[ACT_NAME]
(Pub.
L.
[PLNO])
…
|
3.1)
Amount
payable
([ACT_NAME]
funds
only)
|
[OLDC_PREPOP]
|
3.2)
Carryover Amount - projected unobligated balance ([ACT_NAME]
funds only)
|
[RECIPIENT_ENTRY]
|
3.3)
Projected return of funds to HHS/unobligated balance after
9/30/[FY+1] ([ACT_NAME]
funds only)
If
you
report
an
unobligated
[ACT_NAME]
amount
on line
3.3,
then please
provide
the
following:
|
[OLDC_AUTOCALC]
|
3.3)a)
Briefly
describe
the
types
of
assistance
to
be
provided
with
the
[ACT_NAME]
funds held
available
for
the
following
fiscal
year:
[RECIPIENT_ENTRY]
|
3.3)b)
Briefly
state
the
reasons
that
these
[ACT_NAME]
funds
will
not
be
obligated
in
FFY[FY]:
[RECIPIENT_ENTRY]
|
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
information
may
subject
me
to
criminal,
civil,
or
administrative
penalties.
(U.S.
Code,
Title
18,
Section
1001)
|
a.
Name
of
Authorized
Official:
[RECIPIENT_ENTRY]
|
d.
Telephone:
[RECIPIENT_ENTRY]
|
b.
Title
of
Authorized
Official:
[RECIPIENT_ENTRY]
|
e.
Email
address:
[RECIPIENT_ENTRY]
|
c.
Signature
of
Authorized
Official:
[RECIPIENT_ENTRY]
|
f.
Date
Submitted:
[RECIPIENT_ENTRY]
|
