OMB Control Number: 0970-0558
Expiration Date: 11/23/2023
U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE OF COMMUNITY SERVICES
INSTRUCTIONS FOR LOW INCOME HOUSEHOLD WATER ASSISTANCE PROGRAM FORECAST FORM
PUBLIC REPORTING BURDEN STATEMENT
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to gain an understanding of the expenditure rate at which LIHWAP grant recipients intend to obligate the remining portions of their LIHWAP budget in order to forecast the potential for LIHWAP funds to be remain unobligated at the end of the currently authorized project period, September 30, 2023. The Office of Community Services will use this information to target training and technical assistance and to implement procedures that support the maximum amount of LIHWAP funding being spent on benefit payments for eligible households. Public reporting burden for this collection of information is estimated to average two hours per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information under the authority of the American Rescue Plan Act of 2021 and the Consolidated Appropriations Act of 2021. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0558 and the expiration date is 11/23/2023. If you have any comments on this collection of information, please contact Olivia Barfield, Program Specialist, [email protected].
GENERAL INFORMATION
The LIHWAP Forecast Form identifies both current and future rates of expenditures for grant recipients Low Income Household Water Assistance Program (LIHWAP). Current expenditure rates are identified in Section I of the form. Section I is prepopulated by Federal LIHWAP staff. Sections II and III, as well as remarks are completed by LIHWAP grant recipient staff. Sections II and III forecast expenditure rates for the funds remaining under each of the two funding streams that make up the total LIHWAP award (Consolidated Appropriations Act and American Rescue Plan Act). In Sections II and III, grant recipients should identify the anticipated amount of each funding stream that will be spent during each month of the remaining LIHWAP project period. The forecasted expenditure rates should only include the portion of the LIHWAP budget that has not yet been expended at the time the form is completed.
FORM INSTRUCTIONS
Section I. Current Expenditures
Current Expenditures will be prepopulated. This section includes the following:
CAA Award
CAA Award Spent
CAA Award Remaining
ARPA Award
ARPA Award Spent
ARPA Award Remaining
Total LIHWAP Amount Spent
Total Percent Spent as of (insert date)
Avg. Burn Through Rate Per Month
Total Amount Leftover at Current Rate
Review the data prepopulated by your Program Specialist concerning your remaining funds. Forecasted expenditures will account for the remaining portion of your CAA and ARPA funding only.
Section II CAA Forecasted Expenditures
Estimate the dollar amount from remaining Consolidated Appropriations Act (CAA) funds that you will be able to spend during each month of the currently authorized LIHWAP project period (January 2023- September 2023). The expenditure amount should reflect the demand and anticipated fluctuations for your program, therefore the total amount may vary from month to month. It is okay if you will not be able to spend down all of your award. The total CAA funds you estimate spending will automatically calculate in cell J6.
Enter the dollar amount of CAA funds you estimate spending down in January 2023 into cell A6.
Enter the dollar amount of CAA funds you estimate spending down in February 2023 into cell B6.
Enter the dollar amount of CAA funds you estimate spending down in March 2023 into cell C6.
Enter the dollar amount of CAA funds you estimate spending down in April 2023 into cell D6.
Enter the dollar amount of CAA funds you estimate spending down in May 2023 into cell E6.
Enter the dollar amount of CAA funds you estimate spending down in June 2023 into cell F6.
Enter the dollar amount of CAA funds you estimate spending down in July 2023 into cell G6.
Enter the dollar amount of CAA funds you estimate spending down in August 2023 into cell H6.
Enter the dollar amount of CAA funds you estimate spending down in September 2023 into cell I6.
Section III. ARPA Forecasted Expenditures
Estimate the dollar amount from remaining American Rescue Plan Act (ARPA)funds that you will be able to spend during each month of the currently authorized LIHWAP project period (January 2023- September 2023). The expenditure amount should reflect the demand and anticipated fluctuations for your program, therefore the total amount may vary from month to month. It is okay if you will not be able to spend down all of your award. The total ARPA funds you estimate spending will automatically calculate in cell J9.
Enter the dollar amount of ARPA funds you estimate spending down in January 2023 into cell A9.
Enter the dollar amount of ARPA funds you estimate spending down in February 2023 into cell B9.
Enter the dollar amount of ARPA funds you estimate spending down in March 2023 into cell C9.
Enter the dollar amount of ARPA funds you estimate spending down in April 2023 into cell D9.
Enter the dollar amount of ARPA funds you estimate spending down in May 2023 into cell E9.
Enter the dollar amount of ARPA funds you estimate spending down in June 2023 into cell F9.
Enter the dollar amount of ARPA funds you estimate spending down in July 2023 into cell G9.
Enter the dollar amount of ARPA funds you estimate spending down in August 2023 into cell H9.
Enter the dollar amount of ARPA funds you estimate spending down in September 2023 into cell I9.
Remarks
Add remarks about your estimations at the bottom of the spreadsheet in cell A11 (optional).
Submit Form to The Office of Community Services via email
When you are finished filling out the form, email it to your Program Specialist.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Barfield, Olivia (ACF) |
| File Modified | 0000-00-00 |
| File Created | 2023-07-29 |