DOE F 540.1 SEP Annual File Worksheet

U.S. DEPARTMENT OF ENERGY

DOE F 540.1 (11/2022)
PREVIOUS EDITIONS ARE OBSOLETE

STATE ENERGY PROGRAM NARRATIVE
INFORMATION WORKSHEET

Grant:

Recipient:

OMB Control No. 1910-5126
Expiration Date: 08/31/2023

Program Year:

I. SEO TITLE:
II. REVISION STATUS:
1. Activity:

☐ Economic Development

☐ Education and Outreach

☐ Energy Security

☐ Technical Assistance

☐ Training and/or Workforce Development

☐ Technology Action Group (TAG)

☐ Funding and/or Financing

☐ Policy, Planning, and/or Program Development

2. State:
3. Sector:

☐ Program Management

☐ Agriculture / Agricultural

☐ Institutional

☐ Not Applicable

☐ Commercial

☐ Local Government

☐ Residential

☐ General Public

☐ Manufacturing

☐ State or Territory Government

☐ Buildings

☐ Federal Government

☐ Landlord / Tenant

☐ Private Sector

☐ Rural

☐ Low / Limited Income

☐ K-12 Schools

☐ Multi-state Collaboration

☐ Transportation

☐ Industrial

☐ Non-profits

☐ Utilities

☐ Higher Education

☐ Non-building Infrastructure

4. Technology and/or Topic Areas:

☐ Tribal / Native American

☐ Alternative Fuels and Advanced Vehicle Technologies

☐ Environmental Justice

☐ Audits and Assessments (Energy, Water, and Process)

☐ Geothermal

☐ Biofuels

☐ Hydropower / Hydrokinetic Power

☐ Building Energy Codes or Standards

☐ Not Applicable

☐ Appliance Efficiency or Standards

☐ Fuel Cell and Hydrogen Technologies

☐ Benchmarking

☐ Grid Modernization

☐ Biomass

☐ Natural Gas

☐ Carbon Capture, Utilization and Storage

☐ Propane

☐ Combined Heat and Power

☐ Resiliency

☐ Clean Energy / Clean Energy Technologies

☐ Renewable Energy

☐ Cybersecurity

☐ Smart Grid

☐ Distributed Energy Resources

☐ STEM Education

☐ Electric Vehicles and Infrastructure

☐ Solar

☐ Energy Certification Programs

☐ U.S. DOE Accelerators

☐ Energy Affordability

☐ Storage

☐ Energy Conservation

☐ U.S. DOE Clean Cities

☐ Energy Efficiency

☐ Waste to Energy / Solid Waste Minimization

☐ Energy Equity

☐ Water Nexus

☐ Energy Savings Performance Contracting

☐ Wind

☐ Energy Management

☐ Weatherization

☐ ENERGY STAR

DOE F 540.1 (11/2022)

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Section 508 Compliant

DOE F 540.1 (11/2022)
PREVIOUS EDITIONS ARE OBSOLETE

OMB Control No. 1910-5126
Expiration Date: 08/31/2023

5. Estimated Annual Energy Saving:

6. MBtus:

7. *Description (executive summary of goals and objectives):

8. Program Year Milestones:
Milestone Description

Planned Amount

9. Program Year Metrics:
a) **Specific metric activity (required):

b) *User specified metrics (optional):

10. Program Year Funds by Source:
(a) SEP grant (all funds in the approved budget):
Fund Source

Planned Amount

Total

0

(b) Leveraged funds anticipated (outside approved budget):
Fund Source

Planned Amount

Total

0

*Please use additional pages if more space is needed. **Mandatory requirement

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Section 508 Compliant

DOE F 540.1 (11/2022)
PREVIOUS EDITIONS ARE OBSOLETE

OMB Control No. 1910-5126
Expiration Date: 08/31/2023

PAPERWORK REDUCTION ACT BURDEN DISCLOSURE STATEMENT
This data is being collected to ensure transparency and accountability and adequately gather programmatic and financial, outcome, expenditure and obligation data
to provide metrics showing how the grant recipient is implementing their respective Department of Energy (DOE) funded state plans. The data you supply will be
used by DOE to track and determine program outcomes and respond to Congressional, budget, Office of Management and Budget (OMB) requests and other
inquiries regarding progress on grantees' State Energy Program (SEP) activities.
Public reporting burden for this collection of information is estimated to average 40 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 (1910-5126), 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 (1910-5126),
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 mandatory as appropriate and grant recipients can only view their own reporting using multi-factor authentication.

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