DOE F 540.3 WAP QPR 2022 Form

DOE F 540.3 OMB Control No. 1910-5127

Expiration Date: xx/xx/202X

U.S. Department of Energy

WEATHERIZATION ASSISTANCE PROGRAM

QUARTERLY PROGRAM REPORT

State: _______________ Budget period: / / - / / Grant Number: ________________

I. GRANT OUTLAYS - FUNDS SUBJECT TO DOE PROGRAM RULES (rounded to the nearest dollar)

Reporting Period Quarter	/ - /	/ - /	/ - /	/ - /	Total To Date
	Q1	Q2	Q3	Q4
A. OUTLAYS BY FUND SOURCE
DOE
Other funds included in grant budget, section A
Total Grant Outlays
B. OUTLAYS BY FUNCTION
Grantee Administration
Subgrantee Administration
Grantee T&TA
Subgrantee T&TA
Program Operations Total
Health and Safety
Vehicles and Equipment -- Acquisition Cost *
Liability Insurance
Leveraging
Financial Audits
Weatherization Readiness
Total Grant Outlays
Vehicles and Equipment -- Amortized Cost *

Notes: Total grant outlays must equal outlays reported on the Federal Financial Report, line 10.e.

* Acquisition (actual cost to purchase) vehicle and equipment costs must be included on this form and are used to match net outlays on the FFR. Amortized vehicle and equipment costs are used to calculate the average cost per unit.

U.S. Department of Energy

WEATHERIZATION ASSISTANCE PROGRAM

QUARTERLY PROGRAM REPORT

State: _______________________ Budget period: / / - / / Grant Number:________________

II. GRANT PRODUCTION

Quarter	Q1	Q2	Q3	Q4	Total to Date
A. TOTAL ANNUAL ENERGY SAVINGS (final report only)
B. DOE UNITS* (includes other funds if included in DOE budget)
UNITS BY HOUSING AND FUEL TYPE

Housing Type	Fuel Type Post-Weatherization						Total
	Natural Gas	Electricity	Propane/LP	Fuel Oil	Wood	Other
Owner-Occupied Single Family
Renter-Occupied Single Family
Owner-Occupied 2-4 units
Renter Occupied 2-4 units
Multifamily, 5 or more units
Owner-Occupied Mobile Home
Renter-Occupied Mobile Home
Shelter
Total

	Q1	Q2	Q3	Q4	Total to Date
UNITS BY SUBGRANTEE
Populate list of Subgrantees from Annual File
MULTIFAMILY BUILDINGS (5 or more units per building)
UNITS BY WEATHERIZATION READINESS FUNDS
Owner-Occupied Single Family
Renter-Occupied Single Family
Owner-Occupied 2-4 units
Renter-Occupied 2-4 units
Multifamily, 5 or more units
Owner-Occupied Mobile Home
Renter-Occupied Mobile Home
Shelter
UNITS BY LEVEL OF HOUSEHOLD INCOME (% FPL)
< 75%
76 – 100%
101 – 150%
>150%
Categorically Eligible
UNITS BY OCCUPANCY
Elderly-Occupied
Disabled-Occupied
Native American-Occupied
Children-Occupied
High Residential Energy User
Household with a High Energy Burden
OTHER UNIT CATEGORIES
Reweatherized Total
Window Replacements in Support of the Reduction of Lead-Based Paint Hazards
C. TOTAL PEOPLE ASSISTED WITH GRANT FUNDS* (includes other funds if included in DOE budget)
Elderly
Persons with Disabilities
Native Americans
Children
D. Leveraged Units (units completed with other funds that are not included in DOE budget, any part of the definition of a DOE unit has been met)
E. RENEWABLE ENERGY – Total Installed Capacity
Kilowatts
BTUs per hour

* Do not include reweatherized units in sections B.1, B.2, B.3.

** “Primary Heating Fuel” is the fuel that provides the most space heat in the home post weatherization.

III. COMMENTS

Submitted by_________________________________________________________________ Date_____________

Type name___________________________________________________________________

Title ___________________________________________________________________

OMB Burden Disclosure Statement

Public reporting burden for this collection of information is estimated to average 12 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 Management and Budget, Paperwork Reduction Project (0348-0043), Washington, DC 20503.

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

QUARTERLY PROGRAM REPORT

INSTRUCTIONS

The Quarterly Program Report format is designed to gather production and expenditure data. This report is to be submitted quarterly to the applicable Department of Energy 30 days after the end of the reporting period.

1. GRANT OUTLAYS - FUNDS SUBJECT TO DOE PROGRAM RULES

   1. By fund source: Outlays this quarter and program year to date for

      1. DOE funds

      2. All other funds listed in the grant budget, Section A, including PVE (Exxon, Stripper-Well, etc.), LIHEAP, state, local, and private funds that are part of the approved DOE grant budget.

   2. By function: Outlays this quarter and program year to date for each function in the DOE grant budget, section B. Total must equal total in A.2 above.

      1. Acquisition (actual) vehicle and equipment costs are used to match net outlays in FFR. Amortized vehicle and equipment costs are used to calculate the average cost per unit.

2. GRANT PRODUCTION

Enter figures only for the quarter being reported except to correct previous quarter information. Include reweatherized and low cost/no cost units only in section B.4.

1. Estimated Total Annual Energy Savings Estimate of total annual energy saved as a result of weatherization work. Include in final report only.

2. DOE units completed this quarter with all funds included in the approved DOE grant budget, all sources.

   1. Units by Housing and Fuel Type. Enter the total number of units completed this quarter. The sum should equal total units completed with funds in the approved DOE budget. A completed unit in a building containing five or more units should be reported as a Multi-Family unit. A completed unit in a building containing four units or less should be reported under one of the two Single-Family categories.

   2. Units by Subgrantee. Complete the number of units by Subgrantee completed this quarter. The sum should equal total units completed with funds in the approved DOE budget.

   3. Multifamily Buildings. Enter the total number of multifamily buildings (5 or more units per building) completed this quarter.

   4. Buildings by Weatherization Readiness Funds. Enter the number of buildings completed this quarter that also benefited from DOE Weatherization Readiness Funds. The sum will be less than or equal to the total units completed with funds in the approved DOE budget.

   5. Units by Level of Household Income. Enter the total number of units completed by household income level. For units that are categorically eligible and/or for units where household income level is not available (e.g., units in multifamily buildings where income data is not gathered), use the Categorically Eligible row. The sum should equal total units completed with funds in the approved DOE budget.

   6. Units by occupancy: Number of units completed by category of occupant. The sum will not equal total units completed.

   7. Other categories: Units reweatherized and Window Replacements in Support of the Reduction of Lead-Based Paint Hazards.

3. Persons assisted with funds included in the DOE grant budget, all sources: Total and by category. Sum of persons by category will not equal total persons assisted.

4. Leveraged units completed with other funds not included in the DOE budget provided any part of the definition of a DOE unit has been met.

5. Renewable Energy – Installed Capacity. For all completed units reported this quarter, enter the sum of installed renewable energy system capacity in Kilowatts (e.g., solar photovoltaic systems) and BTUs per hour (e.g., solar thermal systems).

3. COMMENTS

Include here any additional information needed to clarify grant outlays and production reported this quarter.

Submitted by: Signature of the person submitting the report.

Date signed.

Typed name and title of the submitter.

Paperwork Reduction Act Burden Disclosure Statement

This data is being collected to be used by program staff to track Weatherization Assistance Program (WAP) Formula and Bipartisan Infrastructure Law (BIL)/Infrastructure Investment and Jobs Act (IIJA) Funding recipients’ activities, their progress in achieving scheduled milestones, and funds expended. The data you supply will be used for enabling program staff to provide required or requested information on program activities to OMB, Congress, and the public.

Public reporting burden for this collection of information is estimated to average 12 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Enterprise Policy Development & Implementation Office, IM-22, Information Collection Management Program 1910-5127, U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC 20585; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project 1910-5127, Washington, DC 20503.

Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.

Submission of this data is required.

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