DOE F 540.2 SERC Form - Annual File Worksheet

DOE F 540.2
(08/05)

U.S. Department of Energy
WEATHERIZATION ANNUAL FILE WORKSHEET

OMB Control No. 1910-5127
Expiration Date: 6/30/08

Grant #: ________________ Amendment: ________________ State: ________________ Program Year: ________________
Budget Period: ________________
II.3 Subgrantees
Grantee

City

Tentative
Units*
Funding*

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.

II.4 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 Units Weatherized
C 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).

II.5 Energy Savings
Method used to calculate energy savings:
WAP algorithm:
Estimated energy savings (Mbtus): _______________
Other Energy Savings Method Description

II.6 Training, Technical Assistance, and Monitoring Activities

Other (describe below):

DOE F 540.2
(08/05)

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

Grant #: ________________ Amendment: ________________ State: ________________ Program Year: ________________
Budget Period: ________________

II.7 DOE-Funded Leveraging Activities

II.8 Policy Advisory Committee Members

II.9 State Plan Hearings (send notes, minutes, or transcript to the Regional Office)
Hearing Date:
Newspapers that publicized the hearings and the dates that the notice ran.

If desired, hearing notes or transcripts may be cut and pasted into this space.

II.10 Adjustments to On-File Information

II.11 Miscellaneous

DOE F 540.2

OMB Control No. 1910-5127

(08/05)

Expiration Date: 6/30/08

OMB Burden Disclosure Statement
Public reporting burden for this collection of information is estimated to average 3 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of the Chief Information Officer, Records
Management Division, IM-11, Paperwork Reduction Project (1910-5127), U.S. Department of Energy, 19901 Germantown
Road, Germantown, Maryland, 20874 and to the Office of Management and Budget, OIRA, Paperwork Reduction Project
(1910-5127). Washington DC 20503.

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.
Grant Number:
Amendment:
State:
Program Year:
Budget Period:

The seven-digit Federal identification number assigned to the grant (R999999).
If applicable.
Name of state or tribal organization submitting the report.
The beginning and ending dates (mm/dd/yy) for the Program Year reported.
The starting and ending dates (mm/dd/yy) for the budget period for the WAP program year.
Item

Explanation

II.3 Subgrantees
Grantee

Identify each intended subgrantee by name

City

Identify the city in which the agency resides

Funding

Identify the tentative funding each agency will receive

Units

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

II.4 Production Schedule
Total Units

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

Reweatherized Units

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

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

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

II.5 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

II.6 Training, Technical Assistance and
Monitoring Activities

State weatherization training, technical assistance, and monitoring activities
anticipated during this program year, including any publications or materials planned

II.7 DOE-Funded Leveraging Activities

State weatherization leveraging activities anticipated during this program year using
DOE funding

DOE F 540.2
(08/05)

II.8 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
II.9 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 be sent to
the appropriate Regional Office)

II.10 Adjustments to On-File Information Identify any items that have changed since the previous year to the on-file
information stored at the state
II.11 Miscellaneous

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