Form DOE F 540.2 DOE F 540.2 Community Scale Form - Annual File Worksheet

Weatherization Assistance Program Sub-programs

DOE F 540.2 Community Scale Form - Annual File Worksheet- Final

Weatherization Assistance Program Sub-programs - State, Local or Tribal Government

OMB: 1910-5157

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DOE F 540.2

U.S. Department of Energy WEATHERIZATION ANNUAL FILE WORKSHEET

OMB Control No. 1910-5157 Expiration Date: 5/31/2025


Grant #:

Amendment:

State:

Program Year:

Budget Period:

Shape1


    1. Subgrantees


Grantee


City

Tentative

Funding*

Units*













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.


    1. 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).


    1. Shape2 Shape3 Energy Savings

Method used to calculate energy savings: WAP algorithm: Other (describe below): Estimated energy savings (Mbtus):


Shape4
Other Energy Savings Method Description


    1. Shape5
      Training, Technical Assistance, and Monitoring Activities

DOE F 540.2 (08/05)

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


Grant #:

Amendment:

State:

Program Year:

Budget Period:

Shape6


    1. Shape7
      DOE-Funded Leveraging Activities


    1. Policy Advisory Committee Members








    1. 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.


    1. Shape8
      Adjustments to On-File Information


    1. Shape9
      Miscellaneous

DOE F 540.2 (08/05)

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

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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: The seven-digit Federal identification number assigned to the grant (R999999).

Amendment: If applicable.

State: Name of state or tribal organization submitting the report.

Program Year: The beginning and ending dates (mm/dd/yy) for the Program Year reported.

Budget Period: The starting and ending dates (mm/dd/yy) for the budget period for the WAP program year.

Shape11

Item Explanation

Shape12

    1. Subgrantees


Shape13 Grantee Identify each intended subgrantee by name

Shape14 City Identify the city in which the agency resides

Shape15 Funding Identify the tentative funding each agency will receive

Shape16 Units Identify the tentative total of completed units anticipated by the agency with this funding


    1. Production Schedule


Shape17 Total Units Calculate the total units expected to be weatherized for this program year, excluding reweatherized units

Shape18 Reweatherized Units Calculate the number of reweatherized units to be completed this program year

Shape19 Average Unit Costs, including Enter data for and add and subtract, as specified to determine the average unit Reweatherization, Subject to costs for units subject to DOE Program/Rules

DOE Program/Rules


    1. 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


    1. Training, Technical Assistance and State weatherization training, technical assistance, and monitoring activities Monitoring Activities anticipated during this program year, including any publications or materials planned


    1. DOE-Funded Leveraging Activities State weatherization leveraging activities anticipated during this program year using

DOE funding

DOE F 540.2 (08/05)

    1. 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


    1. 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)


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


    1. Miscellaneous Identify and anticipated activities that are not routinely administered as part of the

Weatherization Assistance Program (e.g. disaster relief, energy crisis response)

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title22679
AuthorStan Murgolo
File Modified0000-00-00
File Created2025-06-01

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