Chapter XXVII

Subchapter A

20 CAR pt. 862 Low Income Home Energy Assistance Program (LIHEAP) {#sec-20-car-pt.-862 omnilex-key=us-ar-regs-official--title-20-part-862--20 CAR pt. 862}

DETAILED MODEL PLAN (LIHEAP)

Program Name: Low Income Home Energy Assistance

Grantee Name: ARKANSAS

Report Name: DETAILED MODEL PLAN (LIHEAP) Report Period: 10/01/2017 to 09/30/2018

Report Status: Saved

Report Sections>

Mandatory Grant Application SF-424

Section 1 - Program Components

Section 2 - HEATING ASSISTANCE

Section 3 - COOLING ASSISTANCE

Section 4 - CRISIS ASSISTANCE

Section 5 - WEATHERIZATION ASSISTANCE

Section 6 - Outreach, 2605(b)(3) - Assurance 3, 2605(c)(3)(A)

Section 7 - Coordniation, 2605(b)(4) - Assurance 4

Section 8 - Agency Designation,, 2605(b)(6) - Assurance 6

Section 9 - Energy Suppliers,, 2605(b)(7) - Assurance 7

Section 10 - Program, Fiscal Monitoring, and Audit, 2605(b)(10) - Assurance 10

Section 11 - Timely and Meaningful Public Participation, , 2605(b)(12) - Assurance 12, 2605(c)(2) 24

Section 12 - Fair Hearings, 2605(b)(13) - Assurance 13

Section 13 - Reduction of home energy needs, 2605(b)(16) - Assurance 16

Section 14 - Leveraging Incentive Program ,2607A

Section 15 - Training

Section 16 - Performance Goals and Measures, 2605(b)

Section 17 - Program Integrity, 2605(b)(10)

Section 18: Certification Regarding Debarment, Suspension, and Other Responsibility Matters

Section 19: Certification Regarding Drug-Free Workplace Requirements

Section 20: Certification Regarding Lobbying

Assurances

Plan Attachments

Mandatory Grant Application SF-424

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01 OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

* 1.a. Type of Submission: ☒ Plan ☒ Annual

* 1.b. Frequency:

1.c. Consolidated Application/Plan/Funding Request? Explanation:
1.d. Version: ☒ Initial ☐ ☐ Resubmission ☐ Revision Update

Date Received:

State Use Only:

Applicant Identifier:

4a. Federal Entity Identifier:

Date Received By State:

4b. Federal Award Identifier:

State Application Identifier:

7. APPLICANT INFORMATION

* a. Legal Name: Arkansas Department of Human Services

* b. Employer/Taxpayer Identification Number (EIN/TIN): 71-6007389

* e. Organizational DUNS: 024720901

*d. Address:

Street 1:

OFFICE OF COMMUNITY SERVICES

Street 2:

P.O. BOX 1437 S330

City:

LITTLE ROCK

County:

ARKANSAS

· State:

Province:

Country:

United States

Zip / Postal Code:

72203 - 1437

e. Organizational Unit:

Department Name: Department of Human Services

Division Name:

Office of Community Services

f. Name and contact information of person to be contacted on matters involving this application:

Prefix:

First Name: Shirley

Middle Name:

Last Name: Mason

Suffix:

Title: LIHEAP Manager

Organizational Affiliation:

Telephone Number: (501) 682-8726

Fax Number (501) 682-6736

Email: shirley.mason(@)dhs.arkansas.gov

* 8a. TYPE OF APPLICANT: A: State Government

b. Additional Description:

* 9. Name of Federal Agency:

Catalog of Federal Domestic Assistance Number:

CFDA Title:

CFDA Numbers and Titles

93568

Low-Income Home Energy Assistance

11. Descriptive Title of Applicant's Project Low Income Home Energy Assistance Program

12. Areas Affected by Funding:

13. CONGRESSIONAL DISTRICTS OF:

* a. Applicant 2

b. Program/Project:

Attach an additional list of Program/Project Congressional Districts if needed.

14. FUNDING PERIOD:

15. ESTIMATED FUNDING:

a. Start Date: 10/01/2017

b. End Date: 09/30/2018

a. Federal ($): SO b. Match (S): SO
1. IS SUBMISSION SUBJECT TO REVIEW BY STATE UNDER EXECUTIVE ORDER 12372 PROCESS?

a. This submission was made available to the State under the Executive Order 12372

Process for Review on :

b. Program is subject to E.O. 12372 but has not been selected by State for review.

c. Program is not covered by E.O. 12372.

Is The Applicant Delinquent ☐ YES ☒ NO

On Any Federal Debt?

Explanation:

By signing this application, I certify (1) to the statements contained in the list of certifications"" and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances ** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) ** I Agree ☒

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

18a. Typed or Printed Name

and Title of Authorized Certifying Official

18c. Telephone (area code, number and extension)

18d. Email Address

18b. Signature of Authorized Certifying Official

18e. Date Report Submitted (Month, Day, Year)

Attach supporting documents as specified in agency instructions.

Section 1 - Program Components

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Department of Health and Human Services Administration for Children and Families Office of Community Services Washington, DC 20447

August 1987, revised 05/92, 02/95, 03/96, 12/98, 11/01 OMB Approval No. 0970-0075 Expiration Date: 02/28/2005

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)Use of this model plan is optional. However, the information requested is required in order to receive a Low Income Home Energy Assistance Program (LIHEAP) grant in years in which the grantee is not permitted to file an abbreviated plan. Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

Section 1 Program Components

Program Components, 2605(a), 2605(b)(1) - Assurance 1, 2605(c)(1)(C)

1.1 Check which components you will operate under the LIHEAP program. (Note: You must provide information for each component designated here as requested elsewhere in this plan.)

Dates of Operation

Start Date

End Date

☒

Heating assistance

10/01/2017

09/30/2018

☒

Cooling assistance

10/01/2017

09/30/2018

☒

Crisis assistance

10/01/2017

09/30/2018

☒

Weatherization assistance

10/01/2017

09/30/2018

Provide further explanation for the dates of operation, if necessary

Estimated Funding Allocation, 2604(C), 2605(k)(1), 2605(b)(9), 2605(b)(16) - Assurances 9 and 16

1.2 Estimate what amount of available LIHEAP funds will be used for each component that you will operate: The total of all percentages must add up to 100%.

Percentage ( % )

Heating assistance

40.00%

Cooling assistance

15.00%

Crisis assistance

15.00%

Weatherization assistance

15.00%

Carryover to the following federal fiscal year

0.00%

Administrative and planning costs

10.00%

Services to reduce home energy needs including needs assessment (Assurance 16)

5.00%

Used to develop and implement leveraging activities

0.00%

TOTAL

100.00%

1.3 The funds reserved for winter crisis assistance that have not been expended by March 15 will be reprogrammed to: ☒ Heating assistance ☒ Cooling assistance ☐ Weatherization assistance ☒ Other (specify:) Arkansas will implement a cooling program if adequate funds are available from the winter program and/or if additional program funds are received due to extreme hot temperatures. If one is implemented the same program guidelines which are used in other components would apply.

Categorical Eligibility, 2605(b)(2)(A) - Assurance 2, 2605(c)(1)(A), 2605(b)(8A) - Assurance 8

Yes ☐ No ☒

1.4 Do you consider households categorically eligible if one household member receives one of the following categories of benefits in the left column below? (

If you answered "Yes" to question 1.4, you must complete the table below and answer questions 1.5 and 1.6.

Heating

Cooling

Crisis

Weatherization

TANF

☐ Yes ☐ No

SSI

☐ Yes ☐ No

SNAP

☒ Yes ☐ No

☐ Yes ☒ No

☒ Yes ☐ No

Means-tested Veterans Programs

☐ Yes ☐ No

Program Name

Heating

Cooling

Crisis

Weatherization

Other(Specify) 1

☐ Yes ☐ No

1.5 Do you automatically enroll households without a direct annual application? ☒ Yes ☐ No

If Yes, explain:

Households that have an elderly or a disabled person and receive SNAP benefits are mailed a Potential Eligible Application prior to the start of the LIHEAP Program. If none of the information has changed, then the household would be eligible to receive a payment toward their energy bill.

1.6 How do you ensure there is no difference in the treatment of categorically eligible households from those not receiving other public assistance when determining eligibility and benefit amounts?

The benefit matrix is based on household income for all household members eighteen years and over. All households must meet the eligibility requirements.

SNAP Nominal Payments

1.7a Do you allocate LIHEAP funds toward a nominal payment for SNAP households? ☐ Yes ☒ No If you answered "Yes" to question 1.7a, you must provide a response to questions 1.7b, 1.7c, and 1.7d.

1.7b Amount of Nominal Assistance: $0.00

1.7c Frequency of Assistance ☐ Once Per Year

☐ Once every five years ☐ Other - Describe:

1.7d How do you confirm that the household receiving a nominal payment has an energy cost or need?

Determination of Eligibility - Countable Income

1.8. In determining a household's income eligibility for LIHEAP, do you use gross income or net income ? ☒ Gross Income ☐ Net Income

1.9. Select all the applicable forms of countable income used to determine a household's income eligibility for LIHEAP ☒ Wages

☒ Self - Employment Income ☒ Contract Income

Payments from mortgage or Sales Contracts

☐

☒

Unemployment insurance

☒

Strike Pay

☒

Social Security Administration (SSA ) benefits

☒ Including MediCare deduction ☐ Excluding MediCare deduction

☒

Supplemental Security Income (SSI )

☒

Retirement / pension benefits

☐

General Assistance benefits

☒

Temporary Assistance for Needy Families (TANF) benefits

☐

Supplemental Nutrition Assistance Program (SNAP) benefits

☐

Women, Infants, and Children Supplemental Nutrition Program (WIC) benefits

☐

Loans that need to be repaid

☒

Cash gifts

☐

Savings account balance

☐

One-time lump-sum payments, such as rebates/credits, winnings from lotteries, refund deposits, etc.

☒

Jury duty compensation

☒

Rental income

☐

Income from employment through Workforce Investment Act (WIA)

☐

Income from work study programs

☒

Alimony

☒

Child support

☒

Interest, dividends, or royalties

☒

Commissions

☐

Legal settlements

☐

Insurance payments made directly to the insured

☐

Insurance payments made specifically for the repayment of a bill, debt, or estimate

☒

Veterans Administration (VA) benefits

☐

Earned income of a child under the age of 18

☐ Balance of retirement, pension, or annuity accounts where funds cannot be withdrawn without a penalty.

☐

Income tax refunds

☐

Stipends from senior companion programs, such as VISTA

☒

Funds received by household for the care of a foster child

☐

Ameri-Corp Program payments for living allowances, earnings, and in-kind aid

☐

Reimbursements (for mileage, gas, lodging, meals, etc.)

☐

Other

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 2 - HEATING ASSISTANCE

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 2 - Heating Assistance

Eligibility, 2605(b)(2) - Assurance 2

2.1 Designate the income eligibility threshold used for the heating componenet:

Add

Household size

Eligibility Guideline

Eligibility Threshold

All Household Sizes

State Median Income

60.00%

2.2 Do you have additional eligibility requirements for HEATING ASSITANCE?

☒ Yes ☐ No

2.3 Check the appropriate boxes below and describe the policies for each.

Do you require an Assets test ?

☒ Yes ☐ No

Do you have additional/differing eligibility policies for:

Renters?

☐ Yes ☒ No

Renters Living in subsidized housing ?

☐ Yes ☒ No

Renters with utilities included in the rent ?

☒ Yes ☐ No

Do you give priority in eligibility to:

Elderly?

☒ Yes ☐ No

Disabled?

☒ Yes ☐ No

Young children?

☐ Yes ☒ No

Households with high energy burdens ?

☒ Yes ☐ No

Other?

☐ Yes ☒ No

Explanations of policies for each "yes" checked above:

Higher maximum assets for elderly households. If the household declares that its utilities are included in the rent, documentation must be provided by submitting a copy of a Lease Agreement that specify utilities are included in their rent. Applications are mailed to eligible SNAP households where elderly or persons with a disability reside. The applicant MUST apply in the county in which they reside.

Determination of Benefits 2605(b)(5) - Assurance 5, 2605(c)(1)(B)

2.4 Describe how you prioritize the provision of heating assistance tovulnerable populations,e.g., benefit amounts, early application periods, etc.

Applications are mailed to eligible SNAP households where an elderly or person with a disability resides approximately four weeks prior to the LIHEAP Program Start date. Applicants are advised that applications are processed and paid on a first come basis.

2.5 Check the variables you use to determine your benefit levels. (Check all that apply): ☒ Income ☒ Family (household) size ☒ Home energy cost or need: ☒ Fuel type ☐ Climate/region ☐ Individual bill ☐ Dwelling type

☐ Energy burden (% of income spent on home energy) ☒ Energy need ☐ Other - Describe:

There are additional policies for households that utilize propane, wood or pre-paid electric for heating purposes.

Benefit Levels, 2605(b)(5) - Assurance 5, 2605(c)(1)(B)

2.6 Describe estimated benefit levels for FY 2018:

Minimum Benefit

$52

Maximum Benefit

$309

2.7 Do you provide in-kind (e.g., blankets, space heaters) and/or other forms of benefits? ☒ Yes ☐ No

If yes, describe.

When all other options to provide the household a heating source have been exhausted, the CAAS will provide the household with space heaters.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 3 - COOLING ASSISTANCE

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 3 - Cooling Assistance

Eligibility, 2605(c)(1)(A), 2605 (b)(2) - Assurance 2

3.1 Designate The income eligibility threshold used for the Cooling componenet:

Add

Household size

Eligibility Guideline

Eligibility Threshold

All Household Sizes

State Median Income

60.00%

3.2 Do you have additional eligibility requirements for COOLING ASSITANCE?

☒ Yes ☐ No

3.3 Check the appropriate boxes below and describe the policies for each.

Do you require an Assets test ?

☒ Yes ☐ No

Do you have additional/differing eligibility policies for:

Renters?

☐ Yes ☒ No

Renters Living in subsidized housing ?

☐ Yes ☒ No

Renters with utilities included in the rent ?

☒ Yes ☐ No

Do you give priority in eligibility to:

Elderly?

☒ Yes ☐ No

Disabled?

☒ Yes ☐ No

Young children?

☐ Yes ☒ No

Households with high energy burdens ?

☒ Yes ☐ No

Other?

☐ Yes ☒ No

Explanations of policies for each "yes" checked above:

3.4 Describe how you prioritize the provision of cooling assistance tovulnerable populations,e.g., benefit amounts, early application periods, etc. Applications are mailed to eligible SNAP households where elderly and persons with a disablity reside.

Determination of Benefits 2605(b)(5) - Assurance 5, 2605(c)(1)(B)

3.5 Check the variables you use to determine your benefit levels. (Check all that apply): ☒ Income ☒ Family (household) size ☒ Home energy cost or need: ☒ Fuel type ☐ Climate/region ☐ Individual bill ☐ Dwelling type

☐ Energy burden (% of income spent on home energy) ☒ Energy need ☒ Other - Describe:

Medical Necessity: One or more household members with a medical condition which makes them vulnerable to health hazards from high temperatures. This requirement must be met only for the receipt of an air conditioner when they are distributed as a result of the release of LIHEAP emergency contingency funds to assist households who may be vulnerable to extreme heat.

Benefit Levels, 2605(b)(5) - Assurance 5, 2605(c)(1)(B)

3.6 Describe estimated benefit levels for FY 2018:

Minimum Benefit

$52

Maximum Benefit

$309

3.7 Do you provide in-kind (e.g., fans, air conditioners) and/or other forms of benefits? ☐ Yes ☒ No

If yes, describe.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 4 - CRISIS ASSISTANCE

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 4: CRISIS ASSISTANCE

Eligibility - 2604(c), 2605(c)(1)(A)

4.1 Designate the income eligibility threshold used for the crisis component

Add

Household size

Eligibility Guideline

Eligibility Threshold

All Household Sizes

State Median Income

60.00%

4.2 Provide your LIHEAP program's definition for determining a crisis.

The household must have an energy related emergency situation, instances of extreme hot or cold temperatures or other energy related disasters such as floods, storms, etc. and/or "state of emergency" as designated by the Governor.

4.3 What constitutes a life-threatening crisis?

A household that would suffer a decline in the health conditions of a household member or produce a non-life sustainable environment due to the loss of energy.

4.6 Do you have additional eligibility requirements for CRISIS ASSISTANCE? ☒ Yes ☐ No

4.7 Check the appropriate boxes below and describe the policies for each

Do you require an Assets test ? ☒ Yes ☐ No

Do you give priority in eligibility to : Elderly? ☒ Yes ☐ No

Disabled?

☒ Yes ☐ No

Young Children? ☐ Yes ☒ No

Households with high energy burdens? ☒ Yes ☐ No

Other?

☐ Yes

☒ No

In Order to receive crisis assistance:

Must the household have received a shut-off notice or have a near empty

tank? ☒ Yes ☐ No

Must the household have been shut off or have an empty tank? ☒ Yes ☐ No

Must the household have exhausted their regular heating benefit? ☐ Yes ☒ No

Must renters with heating costs included in their rent have received an eviction notice ? ☒ Yes ☐ No

Must heating/cooling be medically necessary? ☐ Yes ☒ No

Must the household have non-working heating or cooling equipment? ☐ Yes ☒ No

Other?

☐ Yes

☒ No

Do you have additional / differing eligibility policies for:

4.5 Within how many hours do you provide an intervention that will resolve the energy crisis for eligible households in life-threatening situations? 18Hours

Crisis Eligibility, 2605(c)(1)(A)

Crisis Requirement, 2604(c)

4.4 Within how many hours do you provide an intervention that will resolve the energy crisis for eligible households? 48Hours

Renters?

Renters living in subsidized housing?

☐ Yes ☒ No

Renters with utilities included in the rent? ☒ Yes ☐ No

Explanations of policies for each "yes" checked above:

If a household member declares that its utilities are included in the rent, documentation must be provided by submitting a copy of a Lease Agreement that states utilities are included in their rent.

Determination of Benefits

4.8 How do you handle crisis situations? ☒

Separate component ☐

Fast Track

Other - Describe:

4.9 If you have a separate component, how do you determine crisis assistance benefits? ☒

Amount to resolve the crisis. ☐

Other - Describe:

Crisis Requirements, 2604(c)

4.10 Do you accept applications for energy crisis assistance at sites that are geographically accessible to all households in the area to be served? ☒ Yes ☐ No Explain.

Applications for energy assistance are taken at the fifteen local Community Action Agencies located in the seventy-five counties around the state of Arkansas.

4.11 Do you provide individuals who are physically disabled the means to:

Submit applications for crisis benefits without leaving their homes? ☒ Yes ☐ No If No, explain.

Travel to the sites at which applications for crisis assistance are accepted? ☒ Yes ☐ No If No, explain.

If you answered "No" to both options in question 4.11, please explain alternative means of intake to those who are homebound or physically disabled?

Benefit Levels, 2605(c)(1)(B)

4.12 Indicate the maximum benefit for each type of crisis assistance offered.

Winter Crisis

$500.00 maximum benefit

Summer Crisis

$500.00 maximum benefit

Year-round Crisis $0.00 maximum benefit

4.13 Do you provide in-kind (e.g. blankets, space heaters, fans) and/or other forms of benefits? ☒ Yes ☐ No

If yes, Describe

Summer Program distribution of fans to eligible households with medical needs for a cooling appliance during designate application periods.

4.14 Do you provide for equipment repair or replacement using crisis funds? ☒ Yes ☐ No

If you answered "Yes" to question 4.14, you must complete question 4.15.

4.15 Check appropriate boxes below to indicate type(s) of assistance provided.

Winter Crisis

Summer Crisis

Year-round Crisis

Heating system repair

☒

☐

Heating system replacement

☐

Cooling system repair

☐

☒

☐

Cooling system replacement

☐

Wood stove purchase

☐

Pellet stove purchase

☐

Solar panel(s)

☐

Utility poles / gas line hook-ups

☐

Other (Specify):

☐

4.16 Do any of the utility vendors you work with enforce a moratorium on shut offs?

☒ Yes ☒ No

If you responded "Yes" to question 4.16, you must respond to question 4.17.

4.17 Describe the terms of the moratorium and any special dispensation received by LIHEAP clients during or after the moratorium period.

Energy Suppliers, such as gas and electric energy suppliers are regulated by the state Public Service Commission to implement a moratorium in extreme low temperatures or extreme high temperatures. As a result, when the moratorium is lifted, there are a large number of low income households that are faced with usually high energy bills and/or shut offs. Qualifying households are able to apply for LIHEAP Crisis Assistance until all LIHEAP Crisis Assistance funds have been exhausted.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 5 - WEATHERIZATION ASSISTANCE

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 5: WEATHERIZATION ASSISTANCE

Eligibility, 2605(c)(1)(A), 2605(b)(2) - Assurance 2

5.1 Designate the income eligibility threshold used for the Weatherization component

Add

Household Size

Eligibility Guideline

Eligibility Threshold

All Household Sizes

HHS Poverty Guidelines

200.00%

5.2 Do you enter into an interagency agreement to have another government agency administer a WEATHERIZATION component? ☒ Yes ☐ No

5.3 If yes, name the agency. Arkansas Energy Office

5.4 Is there a separate monitoring protocol for weatherization? ☒ Yes ☐ No

WEATHERIZATION - Types of Rules

5.5 Under what rules do you administer LIHEAP weatherization? (Check only one.) ☐ Entirely under LIHEAP (not DOE) rules ☐ Entirely under DOE WAP (not LIHEAP) rules ☐

Mostly under LIHEAP rules with the following DOE WAP rule(s) where LIHEAP and WAP rules differ (Check all that apply): ☐ Income Threshold ☐ Weatherization of entire multi-family housing structure is permitted if at least 66% of units (50% in 2- & 4-unit buildings) are eligible units or will become eligible within 180 days ☐ Weatherize shelters temporarily housing primarily low income persons (excluding nursing homes, prisons, and similar institutional care facilities).

☒ Other - Describe:

Recognizing that LIHEAP does not provide separate funds for Training and Technical Asst. (T&TA) as does DOE, Ark WAP will use Admin funds at the grantee (AEO) and subgrantee levels to provide training and technical asst for the development and maintenance of knowledge, skills and abilities necessary to oversee and provide effective and efficient WAP services. Use of LIHEAP admin funds for T&TA will follow DOE rules. ☒

Mostly under DOE WAP rules, with the following LIHEAP rule(s) where LIHEAP and WAP rules differ (Check all that apply.) ☐ Income Threshold ☐ Weatherization not subject to DOE WAP maximum statewide average cost per dwelling unit. ☐

Weatherization measures are not subject to DOE Savings to Investment Ration (SIR ) standards. ☒ Other - Describe:

The evaluation for repair and replacement of heating systems will be allowable outside of DOE rules in order to provide safe and effective household heating to comply with LIHEAPs focus on health and safety.

Eligibility, 2605(b)(5) - Assurance 5

5.6 Do you require an assets test? ☐ Yes ☒ No

5.7 Do you have additional/differing eligibility policies for : Renters ☐ Yes ☒ No

Renters living in subsidized housing? ☐ Yes ☒ No

5.8 Do you give priority in eligibility to:

Elderly?

☒ Yes ☐ No

Disabled?

☒ Yes ☐ No

Young Children?

☒ Yes ☐ No

House holds with high energy burdens?

☒ Yes ☐ No

Other? HH with high enrgy usage.

☒ Yes ☐ No

If you selected "Yes" for any of the options in questions 5.6, 5.7, or 5.8, you must provide further explanation of these policies in the text field below.

5.8 DOE priorities for services are followed.

Benefit Levels

5.9 Do you have a maximum LIHEAP weatherization benefit/expenditure per household? ☐ Yes ☒ No

5.10 If yes, what is the maximum? $0

Types of Assitance, 2605(c)(1), (B) & (D)

5.11 What LIHEAP weatherization measures do you provide ? (Check all categories that apply.) ☒ Water Heater ☒ Caulking and insulation ☐ Major appliance Repairs ☒ Weatherization needs assessments/audits ☐ Energy related roof repair ☒ Storm windows ☒ Major appliance replacement ☒ Furnace/heating system modifications/ repairs ☒ Windows/sliding glass doors ☒ Cooling system modifications/ repairs

☒ Furnace replacement ☒ Doors ☐ Water conservation measures ☒ Cooling system replacement ☐ Compact florescent light bulbs ☒ Other - Describe: Now using LED light bulds, air ceiling, duct ceiling, genaeral heat waste reduction.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 6 - Outreach, 2605(b)(3) - Assurance 3, 2605(c)(3)(A)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 6: Outreach, 2605(b)(3) - Assurance 3, 2605(c)(3)(A)

6.1 Select all outreach activities that you conduct that are designed to assure that eligible households are made aware of all LIHEAP assistance available: ☒ Place posters/flyers in local and county social service offices, offices of aging, Social Security offices, VA, etc. ☒ Publish articles in local newspapers or broadcast media announcements. ☐ Include inserts in energy vendor billings to inform individuals of the availability of all types of LIHEAP assistance. ☒ Mass mailing(s) to prior-year LIHEAP recipients. ☒ Inform low income applicants of the availability of all types of LIHEAP assistance at application intake for other low-income programs. ☒ Execute interagency agreements with other low-income program offices to perform outreach to target groups. ☒ Other (specify):

Posters are placed in the Community Action Agencies around the state to inform the general public of specific information regarding the Arkansas LIHEAP program.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 7 - Coordniation, 2605(b)(4) - Assurance 4

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075

Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 7: Coordination, 2605(b)(4) - Assurance 4

7.1 Describe how you will ensure that the LIHEAP program is coordinated with other programs available to low-income households (TANF, SSI, WAP, etc.).

☐

Joint application for multiple programs

☒

Intake referrals to/from other programs

☐

One - stop intake centers

☐

Other - Describe:

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 8 - Agency Designation,, 2605(b)(6) - Assurance 6

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 8: Agency Designation, 2605(b)(6) - Assurance 6 (Required for state grantees and the Commonwealth of Puerto Rico)

8.1 How would you categorize the primary responsibility of your State agency? ☐ Administration Agency ☐ Commerce Agency

☒ Community Services Agency

☐ Energy / Environment Agency

☐ Housing Agency

☐ Welfare Agency

☐ Other - Describe:

Alternate Outreach and Intake, 2605(b)(15) - Assurance 15

If you selected "Welfare Agency" in question 8.1, you must complete questions 8.2, 8.3, and 8.4, as applicable.

8.2 How do you provide alternate outreach and intake for HEATING ASSISTANCE?

8.3 How do you provide alternate outreach and intake for COOLING ASSISTANCE?

8.4 How do you provide alternate outreach and intake for CRISIS ASSISTANCE?

8.5 LIHEAP Component Administration.

Heating

Cooling

Crisis

Weatherization

8.5a Who determines client eligibility?

Community Action Agencies

8.5b Who processes benefit payments to gas and electric vendors?

Community Action Agencies

8.5c who processes benefit payments to bulk fuel vendors?

Community Action Agencies

8.5d Who performs installation of weatherization measures?

Community Action Agencies

If any of your LIHEAP components are not centrally-administered by a state agency, you must complete questions 8.6, 8.7, 8.8, and, if applicable, 8.9.

8.6 What is your process for selecting local administering agencies?

LIHEAP utilize the Request For Applications process (RFA) to implement the LIHEAP Program. The state currently partner with the 15 Community Action Agencies. LIHEAP/Weatherization is administered by the Arkansas Department of Energy. RFQ Requets for Qualifications and DOE guidelines. ADEQ subgrant with the Arkansas Community Action Agencies and Non-profit Organizations to complete the work orders for the eligible households.

8.7 How many local administering agencies do you use? 15 LIHEAP and 7 L/W

8.8 Have you changed any local administering agencies in the last year? ☒ Yes ☐ No

8.9 If so, why?

☐

Agency was in noncompliance with grantee requirements for LIHEAP -

☐

Agency is under criminal investigation

☐

Added agency

☒

Agency closed

☐

Other - describe

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 9 - Energy Suppliers,, 2605(b)(7) - Assurance 7

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01 OMB Clearance No .: 0970-0075 Expiration Date: 04/30/2014

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN

Section 9: Energy Suppliers, 2605(b)(7) - Assurance 7

9.1 Do you make payments directly to home energy suppliers?

Heating ☐ Yes ☒ No

Cooling ☐ Yes ☒ No

Crisis ☐ Yes ☒ No

Are there exceptions? ☐ Yes ☒ No

If yes, Describe.

All payments to energy suppliers are made from the sub-grantees (Community Action Agencies). Payments are made to the applicants if the households energy supplier has been disqualified or has chosen not to participate in the program and when utility cost are included in the rent or the household uses wood as its heating source .

9.2 How do you notify the client of the amount of assistance paid?

The clients are sent a (DCO 2001) Notice of Action by mail which details the status of their application. This information includes the LIHEAP payment amount, name of

energy supplier and date the payment will be submitted to the energy supplier.

9.3 How do you assure that the home energy supplier will charge the eligible household, in the normal billing process, the difference between the actual cost of the home energy and the amount of the payment?

Supplier Agreements are signed by all LIHEAP participating energy suppliers between the supplier and the local administering agency as required prior to making a direct payment. The contract outline policies and regulations that will effect the energy suppliers and the LIHEAP client rights are outlined in the agreement as well.

9.4 How do you assure that no household receiving assistance under this title will be treated adversely because of their receipt of LIHEAP assistance?

Random monitoring visits are made to the energy suppliers by the grantee to assure that LIHEAP funds are applied accurately to LIHEAPs households energy accounts and to ensure that LIHEAP participants are not treated adversely.

9.5. Do you make payments contingent on unregulated vendors taking appropriate measures to alleviate the energy burdens of eligible households? ☐ Yes ☒ No

If so, describe the measures unregulated vendors may take.

Payments are made only to vendors that has entered into a Supplier Agreement with the Community Action Agencies. Payments are made to the applicants if the household energy supplier has been disqualified or has chosen not to participate in the LIHEAP Program.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 10 - Program, Fiscal Monitoring, and Audit, 2605(b)(10) - Assurance 10

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 10: Program, Fiscal Monitoring, and Audit, 2605(b)(10)

10.1. How do you ensure good fiscal accounting and tracking of LIHEAP funds?

The Department of Human Services is required to follow the Department of Finance and Administration policies and procedures. The department of Human Services also adhere to federal regulations and state fiscal policies. Sub-Grantee request for disbursements are reviewed weekly and compared to our in house reports regarding the balance of cash in relation to reported and planned expenditures.

Audit Process

10.2. Is your LIHEAP program audited annually under the Single Audit Act and OMB Circular A - 133? 0 Yes ☒ No

10.3. Describe any audit findings rising to the level of material weakness or reportable condition cited in the A-133 audits, Grantee monitoring assessments, inspector general reviews, or other government agency reviews of the LIHEAP agency from the most recently audited fiscal year.

No Findings

☒

Finding

Type

Brief Summary

Resolved?

Action Taken

10.4. Audits of Local Administering Agencies

What types of annual audit requirements do you have in place for local adminstering agencies/district offices? Select all that apply. ☒ Local agencies/district offices are required to have an annual audit in compliance with Single Audit Act and OMB Circular A-133 ☐

Local agencies/district offices are required to have an annual audit (other than A-133) ☐ Local agencies/district offices' A-133 or other independent audits are reviewed by Grantee as part of compliance process. ☒ Grantee conducts fiscal and program monitoring of local agencies/district offices

Compliance Monitoring

10.5. Describe the Grantee's strategies for monitoring compliance with the Grantee's and Federal LIHEAP policies and procedures: Select all that apply

Grantee employees: ☒ Internal program review ☒ Departmental oversight ☒ Secondary review of invoices and payments ☐ Other program review mechanisms are in place. Describe:

Local Adminstering Agencies / District Offices: ☒ On - site evaluation ☒ Annual program review

☐ Monitoring through central database ☒ Desk reviews ☒ Client File Testing / Sampling ☐ Other program review mechanisms are in place. Describe:

10.6 Explain, or attach a copy of your local agency monitoring schedule and protocol.

Please see the attachments.

10.7. Describe how you select local agencies for monitoring reviews.

Site Visits:

All agencies are monitored annually for each LIHEAP program implemented. With the implementation of both a Winter LIHEAP program and a Summer Cooling program. The CAAs would have 2 to 3 monitoring reviews annually. The monitoring reviews are specific and typically last from 3 days to 3 weeks depending on the CAAs county service area or population served.

Desk Reviews:

A review is implemented with clients files and the information is also used to review payment information directly made from the Community Action Agencies to the energy suppliers based on the information extracted from the clients records.

10.8. How often is each local agency monitored ?

All Sub-grantee LIHEAP program activities are monitored for each LIHEAP program annually or as needed by DCO staff to ensure compliance with DCO policies and

procedures, administrative efficiency and effectiveness of the LIHEAP program.

10.9. What is the combined error rate for eligibility determinations? OPTIONAL

10.10. What is the combined error rate for benefit determinations? OPTIONAL

10.11. How many local agencies are currently on corrective action plans for eligibility and/or benefit determination issues? 12

10.12. How many local agencies are currently on corrective action plans for financial accounting or administrative issues? 0

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 11 - Timely and Meaningful Public Participation, , 2605(b)(12) - Assurance 12, 2605(c)(2)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 11: Timely and Meaningful Public Participation, 2605(b)(12), 2605(C)(2)

11.1 How did you obtain input from the public in the development of your LIHEAP plan? Select all that apply.

☐ Tribal Council meeting(s) ☒ Public Hearing(s) ☒ Draft Plan posted to website and available for comment ☒ Hard copy of plan is available for public view and comment ☒ Comments from applicants are recorded ☒ Request for comments on draft Plan is advertised ☐ Stakeholder consultation meeting(s) ☐ Comments are solicited during outreach activities ☐ Other - Describe:

A legal notice is published in the state wide newspaper advising the availability of the state plan, informing the public of location and dates of public hearings to be held in separate areas of the state and providing an address for written comment.

11.2 What changes did you make to your LIHEAP plan as a result of this participation?

The Public Hearings Comments did not require changes to the Arkansas State Plan.

Public Hearings, 2605(a)(2) - For States and the Commonwealth of Puerto Rico Only

11.3 List the date and location(s) that you held public hearing(s) on the proposed use and distribution of your LIHEAP funds?

Date

Event Description

08/01/2017

Public Hearings were helded in Pine Bluff, Arkansas

08/01/2017

Monticello, AR

08/02/2017

Jonesboro, AR

08/03/2017

Fort Smith, AR

11.4. How many parties commented on your plan at the hearing(s)? 0

11.5 Summarize the comments you received at the hearing(s).

Please view Public Hearings Attachment.

11.6 What changes did you make to your LIHEAP plan as a result of the comments received at the public hearing(s)?

No changes have been made to the Arkansas LIHEAP program to date regarding as a result of Public Hearings.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 12 - Fair Hearings,2605(b)(13) - Assurance 13

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96, 12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 12: Fair Hearings, 2605(b)(13) - Assurance 13

12.1 How many fair hearings did the grantee have in the prior Federal fiscal year? 1

12.2 How many of those fair hearings resulted in the initial decision being reversed? 0

12.3 Describe any policy and/or procedural changes made in the last Federal fiscal year as a result of fair hearings?

There were no changes to LIHEAP policy as a result of a Fair Hearings.

12.4 Describe your fair hearing procedures for households whose applications are denied.

Applicants are informed of their rights to appeal any decision made regarding their application and/or assistance. The right to appeal the denial of the household's application is also indicated on the Notice of Action (DCO 2001) to inform the household of the action on the application.

12.5 When and how are applicants informed of these rights?

The applicants rights are listed on all LIHEAP applications (LIHEAP 9495, Abbreviated and PE 2096) and are clarified during the interview process with the applicants.

12.6 Describe your fair hearing procedures for households whose applications are not acted on in a timely manner.

Applicants may request a hearing regarding claims not acted upon in a timely manner unless the delay is due to the lack of cooperation on the part of the applicant in providing necessary information so that eligibility can be established.

12.7 When and how are applicants informed of these rights?

The applicants' rights regarding the disposition of the applications are listed on the LIHEAP application and are clarified during the interview process with applicants.

Catagory 6 and 7 of the Applicants Rights state:

6. The applicant will be sent written notification of the disposition of the application within 30 days of the Regular Assistance and within 18/48 hours for Crisis Intervention.

7. The applicant if eligible, will receive payment, goods or services within 35 days for Regular and 20 days for Crisis Intervention.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 13 - Reduction of home energy needs,2605(b)(16) - Assurance 16

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 13: Reduction of home energy needs, 2605(b)(16) - Assurance 16

13.1 Describe how you use LIHEAP funds to provide services that encourage and enable households to reduce their home energy needs and thereby the need for energy assistance?

Assurance 16 activities are services provided which encourage and enable households to reduce their home energy needs and thereby, their need for energy assistance through achieving a higher degree of self-sufficiency. These activities may include, but are not limited to; Needs Assessments, Counseling, Assistance with Energy Suppliers, referrals to other coordinated services, presenting educational programs on fuel usage, meter reading, household budgeting, etc.

Case Management Activities (CMA) will be targeted toward applicants of the Crisis Intervention Program and when deemed appropriate and necessary, the Regular Assistance Program.

13.2 How do you ensure that you don't use more than 5% of your LIHEAP funds for these activities?

No more than 5% of the LIHEAP funds are allocated and transferred to sub grantee agencies who implement these activities. Monitoring and review of the budgeting and allocation process helps to ensure that the total amount of funds expended does not exceed 5% of the LIHEAP funds.

13.3 Describe the impact of such activities on the number of households served in the previous Federal fiscal year.

The Assurance 16 Case Management Programs are educational based with an emphasis on the household budgeting skills and energy conservation to promote self sufficiency and to lessen the household energy burden. Most of the Assurance 16 participants have reported a decrease in energy usage and increase in the ability to budget household expenditures therefore promoting a healthier environment for a total of 783 households.

13.4 Describe the level ofdirect benefitsprovided to those households in the previous Federal fiscal year.

No more than 5% of the LIHEAP funds are allocated and transferred to subgrantee agencies to implement A16 activities. There was a total of $1,083,466.00 allocated to the 16 CAAs for the Assurance 16 component. A total of $650,080.00 was paid in direct services on behalf of A16 households to utility suppliers and in some cases the repair or replacement of Energy Star appliances.

13.5 How many households applied for these services? 901

13.6 How many households received these services? 783

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 14 - Leveraging Incentive Program ,2607A

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 14:Leveraging Incentive Program, 2607(A)

14.1 Do you plan to submit an application for the leveraging incentive program? ☒ Yes ☐ No

14.2 Describe instructions to any third parties and/or local agencies for submitting LIHEAP leveraging resource information and retaining records.

The following funds should be included in Arkansas Funds for Leverage: cash contributions from various churches, faith-based organizations and fuel funds to assist low income households with energy bills, funds that are used in conjunction with LIHEAP when those benefits are insufficient to meet the household's need and/or when LIHEAP benefits have been depleted.

14.3 For each type of resource and/or benefit to be leveraged in the upcoming year that will meet the requirements of45 C.F.R. Â§ 96.87(d)(2)(iii),describe the following:

Resource

What is the type of resource or benefit ?

What is the source(s) of the resource ?

How will the resource be integrated and coordinated with LIHEAP?

Entergy Arkansas Power to Care

Employee and public donations and also Entergy Arkansas fundraisers

Program starts when LIHEAP benefits have been depleted. This program targets persons 60 and older and persons with disabilities.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 15 - Training

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96, 12/98,11/01 OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 15: Training

15.1 Describe the training you provide for each of the following groups:

a. Grantee Staff: ☐ Formal training on grantee policies and procedures

How often? ☒ Annually ☐ Biannually ☒ As needed ☐ Other - Describe: ☒ Employees are provided with policy manual ☐ Other-Describe:

b. Local Agencies: ☒ Formal training conference

How often? ☒ Annually ☐ Biannually ☒ As needed ☐ Other - Describe: ☐ On-site training

How often? ☐ Annually ☐ Biannually ☒ As needed ☐ Other - Describe: ☒ Employees are provided with policy manual ☐ Other - Describe

c. Vendors ☒ Formal training conference

How often? ☒ Annually ☐ Biannually ☒ As needed ☐ Other - Describe:

☒ Policies communicated through vendor agreements ☐ Policies are outlined in a vendor manual ☒ Other - Describe: Formal training is offered to Utility Suppliers annually.

15.2 Does your training program address fraud reporting and prevention? ☒ Yes ☐ No

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01

OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 16: Performance Goals and Measures, 2605(b) - Required for States Only

16.1 Describe your progress toward meeting the data collection and reporting requirements of the four required LIHEAP performance measures. Include timeframes and plans for meeting these requirements and what you believe will be accomplished in the coming federal fiscal year. 1) The LIHEAP application has been revised to capture primary and secondary energy suppliers alone with account numbers.

2) Waiver language was added into the Supplier Agreement for the release of information on account holders or LIHEAP households.

3) Continuing to work with Energy Suppliers regarding the collection of information, format and any software issues or concerns.

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 17 - Program Integrity, 2605(b)(10)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES

August 1987, revised 05/92,02/95,03/96,12/98,11/01 OMB Clearance No .: 0970-0075 Expiration Date: 06/30/2017

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 17: Program Integrity, 2605(b)(10)

17.1 Fraud Reporting Mechanisms

a. Describe all mechanisms available to the public for reporting cases of suspected waste, fraud, and abuse. Select all that apply. ☒ Online Fraud Reporting ☒ Dedicated Fraud Reporting Hotline ☒ Report directly to local agency/district office or Grantee office ☒

☐

Report to State Inspector General or Attorney General

Forms and procedures in place for local agencies/district offices and vendors to report fraud, waste, and abuse ☐ Other - Describe:

b. Describe strategies in place for advertising the above-referenced resources. Select all that apply ☒ Printed outreach materials ☒ Addressed on LIHEAP application ☒ Website ☐ Other - Describe:

17.2. Identification Documentation Requirements

a. Indicate which of the following forms of identification are required or requested to be collected from LIHEAP applicants or their household members.

Type of Identification Collected

Collected from Whom?

Applicant Only

All Adults in Household

All Household Members

Social Security Card is photocopied and retained

☐

Required

☐

Required

☐

Required

☐

Requested

☐

Requested

☐

Requested

Social Security Number (Without actual Card)

☒

Required

☒

Required

☒

Required

☐

Requested

☐

Requested

☐

Requested

Government-issued identification card (ie .: driver's license, state ID, Tribal ID, passport, etc.)

☒

Required

☐

Required

☐

Required

☐

Requested

☐

Requested

☐

Requested

All Adults in

All Household

Other

Applicant Only Required

Applicant Only Requested

Household Required

Household Requested

Members Required

Members Requested

Other supporting documentation is used to verify the applicant; utility bills to verify residents, SSI/SSA, check stubs, child support documentation, bank statements, workforce, DHS, VA Award letter, etc.

☐

☒

b. Describe any exceptions to the above policies.

17.3 Identification Verification

Describe what methods are used to verify the authenticity of identification documents provided by clients or household members. Select all that apply ☐ Verify SSNs with Social Security Administration ☐

☐ Match SSNs with state eligibility/case management system (e.g., SNAP, TANF) Match SSNs with death records from Social Security Administration or state agency ☐ Match with state Department of Labor system ☐ Match with state and/or federal corrections system ☐ Match with state child support system ☐

Verification using private software (e.g., The Work Number) ☐

☐

In-person certification by staff (for tribal grantees only)

Match SSN/Tribal ID number with tribal database or enrollment records (for tribal grantees only)

☒ Other - Describe:

1. Supporting documentation and State I.D. will be used to verify applicants.

2. Utility Bills will be used to verify residence.

3. Documentation for eligibility or household income; SSI/SSA, Check Stubs, Child Support Enforcement, Bank Staterent, Work Force, DHS, VA Award Letter, etc.

17.4. Citizenship/Legal Residency Verification ☒ Clients sign an attestation of citizenship or legal residency

What are your procedures for ensuring that household members are U.S. citizens or aliens who are qualified to receive LIHEAP benefits? Select all that apply. ☒

Client's submission of Social Security cards is accepted as proof of legal residency ☒ Noncitizens must provide documentation of immigration status ☐ Citizens must provide a copy of their birth certificate, naturalization papers, or passport ☐ Noncitizens are verified through the SAVE system ☐ Tribal members are verified through Tribal enrollment records/Tribal ID card ☐ Other - Describe:

17.5. Income Verification

What methods does your agency utilize to verify household income? Select all that apply. ☒ Require documentation of income for all adult household members ☒ Pay stubs ☒ Social Security award letters ☒ Bank statements ☒ Tax statements ☒ Zero-income statements ☒ Unemployment Insurance letters ☐ Other - Describe:

☐ Computer data matches: ☐ Income information matched against state computer system (e.g., SNAP, TANF)

☐ Proof of unemployment benefits verified with state Department of Labor ☐ Social Security income verified with SSA ☐ Utilize state directory of new hires ☐ Other - Describe:

17.6. Protection of Privacy and Confidentiality

☒

Describe the financial and operating controls in place to protect client information against improper use or disclosure. Select all that apply.

☒

Policy in place prohibiting release of information without written consent

Grantee LIHEAP database includes privacy/confidentiality safeguards ☒ Employee training on confidentiality for: ☒ Grantee employees ☒ Local agencies/district offices ☒ Employees must sign confidentiality agreement ☒ Grantee employees ☒ Local agencies/district offices ☒ Physical files are stored in a secure location ☐ Other - Describe:

17.7. Verifying the Authenticity

What policies are in place for verifying vendor authenticity? Select all that apply. ☐ All vendors must register with the State/Tribe. ☐ All vendors must supply a valid SSN or TIN/W-9 form ☒ Vendors are verified through energy bills provided by the household ☒ Grantee and/or local agencies/district offices perform physical monitoring of vendors ☐ Other - Describe and note any exceptions to policies above:

17.8. Benefits Policy - Gas and Electric Utilities ☐ Applicants required to submit proof of physical residency ☐

What policies are in place to protect against fraud when making benefit payments to gas and electric utilities on behalf of clients? Select all that apply.

Applicants must submit current utility bill ☒ Data exchange with utilities that verifies: ☒ Account ownership ☒ Consumption ☒ Balances ☒ Payment history ☐ Account is properly credited with benefit ☐ Other - Describe: ☐ Centralized computer system/database tracks payments to all utilities ☐

Centralized computer system automatically generates benefit level ☐ Separation of duties between intake and payment approval ☐ Payments coordinated among other energy assistance programs to avoid duplication of payments ☐

☐ Payments to utilities and invoices from utilities are reviewed for accuracy ☐ Direct payment to households are made in limited cases only

Computer databases are periodically reviewed to verify accuracy and timeliness of payments made to utilities

☐ Procedures are in place to require prompt refunds from utilities in cases of account closure ☐ Vendor agreements specify requirements selected above, and provide enforcement mechanism ☐ Other - Describe:

17.9. Benefits Policy - Bulk Fuel Vendors

What procedures are in place for averting fraud and improper payments when dealing with bulk fuel suppliers of heating oil, propane, wood, and other bulk fuel vendors? Select all that apply. Two-party checks are issued naming client and vendor ☒ ☐ Vendors are only paid once they provide a delivery receipt signed by the client ☐ Vendors are checked against an approved vendors list ☐ Centralized computer system/database is used to track payments to all vendors ☒ Clients are relied on for reports of non-delivery or partial delivery ☒ Direct payment to households are made in limited cases only ☐ Conduct monitoring of bulk fuel vendors ☐ Bulk fuel vendors are required to submit reports to the Grantee ☒

☐ Other - Describe:

Vendor agreements specify requirements selected above, and provide enforcement mechanism

17.10. Investigations and Prosecutions

Describe the Grantee's procedures for investigating and prosecuting reports of fraud, and any sanctions placed on clients/staff/vendors found to have committed fraud. Select all that apply. ☐ Refer to state Inspector General ☐ Refer to local prosecutor or state Attorney General ☐ Refer to US DHHS Inspector General (including referral to OIG hotline) ☒ Local agencies/district offices or Grantee conduct investigation of fraud complaints from public ☒ Grantee attempts collection of improper payments. If so, describe the recoupment process

We request repayment of funds and if the funds are not repaid the Vendor becomes disqualified to participate in the LIHEAP Program. ☐ Clients found to have committed fraud are banned from LIHEAP assistance. For how long is a household banned? ☐

☒ Contracts with local agencies require that employees found to have committed fraud are reprimanded and/or terminated

Vendors found to have committed fraud may no longer participate in LIHEAP ☐ Other - Describe:

If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.

Section 18: Certification Regarding Debarment, Suspension, and Other Responsibility Matters

Certification Regarding Debarment, Suspension, and Other Responsibility Matters -- Primary Covered Transactions

Instructions for Certification

1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below.

2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction.

3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.BrBbr.

4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

5. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations.

6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction.

7. The prospective primary participant further agrees by submitting this proposal that it

will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.

9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.

Certification Regarding Debarment, Suspension, and Other Responsibility Matters -- Primary Covered Transactions

(1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:

(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency;

(b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and

(d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.

(2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -- Lower Tier Covered Transactions

Instructions for Certification

1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below.

2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or had become erroneous by reason of changed circumstances.

4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations.

5. The prospective lower tier participant agrees by submitting this proposal that, [[Page 33043]] should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.

6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.

8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

Certification Regarding Debarment, Suspension, Ineligibility an Voluntary Exclusion -- Lower Tier Covered Transactions

(1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

(2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. ☒ By checking this box, the prospective primary participant is providing the certification set out above.

Section 19: Certification Regarding Drug-Free Workplace Requirements

This certification is required by the regulations implementing the Drug-Free Workplace Act of 1988: 45 CFR Part 76, Subpart, F. Sections 76.630(c) and (d)(2) and 76.645(a)(1) and (b) provide that a Federal agency may designate a central receipt point for STATE-WIDE AND STATE AGENCY-WIDE certifications, and for notification of criminal drug convictions. For the Department of Health and Human Services, the central pint is: Division of Grants Management and Oversight, Office of Management and Acquisition, Department of Health and Human Services, Room 517-D, 200 Independence Avenue, SW Washington, DC 20201.

Certification Regarding Drug-Free Workplace Requirements (Instructions for Certification)

1. By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out below.

2. The certification set out below is a material representation of fact upon which reliance is placed when the agency awards the grant. If it is later determined that the grantee knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, the agency, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug-Free Workplace Act.

3. For grantees other than individuals, Alternate I applies.

4. For grantees who are individuals, Alternate Il applies.

5. Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If known, they may be identified in the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no application, the grantee must keep the identity of the workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all known workplaces constitutes a violation of the grantee's drug-free workplace requirements.

6. Workplace identifications must include the actual address of buildings (or parts of buildings) or other sites where work under the grant takes place. Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State highway department while in operation, State employees in each local unemployment office, performers in concert halls or radio studios).

7. If the workplace identified to the agency changes during the performance of the grant, the grantee shall inform the agency of the change(s), if it previously identified the workplaces in question (see paragraph five).

8. Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free Workplace common rule apply to this certification. Grantees' attention is called, in particular, to the following definitions from these rules:

Controlled substance means a controlled substance in Schedules I through V of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation (21 CFR 1308.11 through 1308.15);

Conviction means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes;

Criminal drug statute means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or possession of any controlled substance;

Employee means the employee of a grantee directly engaged in the performance of work under a grant, including: (i) All direct charge employees; (ii) All indirect charge employees unless their impact or involvement is insignificant to the performance of the grant; and, (iii) Temporary personnel and consultants who are directly engaged in the performance of work under the grant and who are on the grantee's payroll. This definition does not include workers not on the payroll of the grantee (e.g., volunteers, even if used to meet a matching requirement; consultants or independent contractors not on the grantee's payroll; or employees of subrecipients or subcontractors in covered workplaces).

Certification Regarding Drug-Free Workplace Requirements

Alternate I. (Grantees Other Than Individuals) The grantee certifies that it will or will continue to provide a drug-free workplace by:,

(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition;

(b) Establishing an ongoing drug-free awareness program to inform employees about --

(1)The dangers of drug abuse in the workplace;

(2) The grantee's policy of maintaining a drug-free workplace;

(3) Any available drug counseling, rehabilitation, and employee assistance programs; and

(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a);

(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will --

(1) Abide by the terms of the statement; and

(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; (e) Notifying the agency in writing, within ten calendar days after receiving notice under paragraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant;

(f) Taking one of the following actions, within 30 calendar days of receiving notice under paragraph (d)(2), with respect to any employee who is so convicted -(1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or

(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;

(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f).

(B) The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:

Place of Performance (Street address, city, county, state, zip code)

Department of Human Services * Address Line 1

700 Main Street Address Line 2

Address Line 3

Little Rock/Pulaski County * City

72203

State
Zip Code

Check if there are workplaces on file that are not identified here.

Alternate II. (Grantees Who Are Individuals)

(a) The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant;

(b) If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, he or she will report the conviction, in writing, within 10 calendar days of the conviction, to every grant officer or other designee, unless the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point, it shall include the identification number(s) of each affected grant.

[55 FR 21690, 21702, May 25, 1990] ☒ By checking this box, the prospective primary participant is providing the certification set out above.

Section 20: Certification Regarding Lobbying

The submitter of this application certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance

The undersigned states, to the best of his or her knowledge and belief, that:

If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

☒ By checking this box, the prospective primary participant is providing the certification set out above.

Assurances

(1) use the funds available under this title to --

(A) conduct outreach activities and provide assistance to low income households in meeting their home energy costs, particularly those with the lowest incomes that pay a high proportion of household income for home energy, consistent with paragraph (5);

(B) intervene in energy crisis situations;

(D)plan, develop, and administer the State's program under this title including leveraging programs, and the State agrees not to use such funds for any purposes other than those specified in this title;

(2) make payments under this title only with respect to --

(A) households in which one or more individuals are receiving --

(i)assistance under the State program funded under part A of title IV of the Social Security Act;

(ii) supplemental security income payments under title XVI of the Social Security Act;

(iii) food stamps under the Food Stamp Act of 1977; or

(iv) payments under section 415, 521, 541, or 542 of title 38, United States Code, or under section 306 of the Veterans' and Survivors' Pension Improvement Act of 1978; or

(B) households with incomes which do not exceed the greater of -

(i) an amount equal to 150 percent of the poverty level for such State; or

(ii) an amount equal to 60 percent of the State median income;

(except that a State may not exclude a household from eligibility in a fiscal year solely on the basis of household income if such income is less than 110 percent of the poverty level for such State, but the State may give priority to those households with the highest home energy costs or needs in relation to household income.

(3) conduct outreach activities designed to assure that eligible households, especially households with elderly individuals or disabled individuals, or both, and households with high home energy burdens, are made aware of the assistance available under this title, and any similar energy-related assistance available under subtitle B of title VI (relating to community services block grant program) or under any other provision of law which carries out programs which were administered under the Economic Opportunity Act of 1964 before the date of the enactment of this Act;(4) coordinate its activities under this title with similar and related programs administered by the Federal Government and such State, particularly low-income energy-related programs under subtitle B of title VI (relating to community services block grant program), under the supplemental security income program, under part A of title IV of the Social Security Act, under title XX of the Social Security Act, under the low-income weatherization assistance program under title IV of the Energy Conservation and Production Act, or under any other provision of law which carries out programs which were administered under the Economic Opportunity Act of 1964 before the date of the enactment of this Act;(5) provide, in a timely manner, that the highest level of assistance will be furnished to those households which have the lowest incomes and the highest energy costs or needs in relation to income, taking into account family size, except that the State may not differentiate in implementing this section between the households described in clauses 2(A) and 2(B) of this subsection;

(6) to the extent it is necessary to designate local administrative agencies in order to carry out the purposes of this title, to give special consideration, in the designation of such agencies, to any local public or private nonprofit agency which was receiving Federal funds under any low-income energy assistance program or weatherization program under the Economic Opportunity Act of 1964 or any other provision of law on the day before the date of the enactment of this Act, except that -

(A) the State shall, before giving such special consideration, determine that the agency involved meets program and fiscal requirements established by the State; and

(B) if there is no such agency because of any change in the assistance furnished to programs for economically disadvantaged persons, then the State shall give special consideration in the designation of local administrative agencies to any successor agency which is operated in substantially the same manner as the predecessor agency which did receive funds for the fiscal year preceding the fiscal year for which the determination is made;

(7) if the State chooses to pay home energy suppliers directly, establish procedures to --

(A) notify each participating household of the amount of assistance paid on its behalf;

(B) assure that the home energy supplier will charge the eligible household, in the normal billing process, the difference between the actual cost of the home energy and the amount of the payment made by the State under this title;

(C) assure that the home energy supplier will provide assurances that any agreement entered into with a home energy supplier under this paragraph will contain provisions to assure that no household receiving assistance under this title will be treated adversely because of such assistance under applicable provisions of State law or public regulatory requirements; and

(D) ensure that the provision of vendor payments remains at the option of the State in consultation with local grantees and may be contingent on unregulated vendors taking appropriate measures to alleviate the energy burdens of eligible households, including providing for agreements between suppliers and individuals eligible for benefits under this Act that seek to reduce home energy costs, minimize the risks of home energy crisis, and encourage regular payments by individuals receiving financial assistance for home energy costs;

(8) provide assurances that,

(A) the State will not exclude households described in clause (2)(B) of this subsection from receiving home energy assistance benefits under clause (2), and

(B) the State will treat owners and renters equitably under the program assisted under this title;

(9) provide that --

(A) the State may use for planning and administering the use of funds under this title an amount not to exceed 10 percent of the funds payable to such State under this title for a fiscal year; and

(B) the State will pay from non-Federal sources the remaining costs of planning and administering the program assisted under this title and will not use Federal funds for such remaining cost (except for the costs of the activities described in paragraph (16));

(10) provide that such fiscal control and fund accounting procedures will be established as may be necessary to assure the proper disbursal of and accounting for Federal funds paid to the State under this title, including procedures for monitoring the assistance provided under this title, and provide that the State will comply with the provisions of chapter 75 of title 31, United States Code (commonly known as the "Single Audit Act");

(11) permit and cooperate with Federal investigations undertaken in accordance with section 2608;

(12) provide for timely and meaningful public participation in the development of the plan described in subsection (c);

(13) provide an opportunity for a fair administrative hearing to individuals whose claims for assistance under the plan described in subsection (c) are denied or are not acted upon with reasonable promptness; and

(14) cooperate with the Secretary with respect to data collecting and reporting under section 2610.

(15) * beginning in fiscal year 1992, provide, in addition to such services as may be offered by State Departments of Public Welfare at the local level, outreach and intake functions for crisis situations and heating and cooling assistance that is administered by additional State and local governmental entities or community-based organizations (such as community action agencies, area agencies on aging and not-for-profit neighborhood-based organizations), and in States where such organizations do not administer functions as of September 30, 1991, preference in awarding grants or contracts for intake services shall be provided to those agencies that administer the low-income weatherization or energy crisis intervention programs.

* This assurance is applicable only to States, and to territories whose annual regular LIHEAP allotments exceed $200,000. Neither territories with annual allotments of $200,000 or less nor Indian tribes/tribal organizations are subject to Assurance 15.

(16) use up to 5 percent of such funds, at its option, to provide services that encourage and enable households to reduce their home energy needs and thereby the need for energy assistance, including needs assessments, counseling, and assistance with energy vendors, and report to the Secretary concerning the impact of such activities on the number of households served, the level of direct benefits provided to those households, and the number of households that remain unserved.

Plan Attachments

PLAN ATTACHMENTS

The following documents must be attached to this application

· Delegation Letter is required if someone other than the Governor or Chairman Certified this Report.

· Heating component benefit matrix, if applicable

· Cooling component benefit matrix, if applicable

· Minutes, notes, or transcripts of public hearing(s).

20 CAR Part 862 — Low Income Home Energy Assistance Program (LIHEAP)

Chapter XXVII

Subchapter A

20 CAR pt. 862 Low Income Home Energy Assistance Program (LIHEAP) {#sec-20-car-pt.-862 omnilex-key=us-ar-regs-official--title-20-part-862--20 CAR pt. 862}

DETAILED MODEL PLAN (LIHEAP)

Report Sections>

Mandatory Grant Application SF-424

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 1 - Program Components

Section 1 Program Components

Section 2 - HEATING ASSISTANCE

Section 2 - Heating Assistance

Section 3 - COOLING ASSISTANCE

Section 3 - Cooling Assistance

3.1 Designate The income eligibility threshold used for the Cooling componenet:

Section 4 - CRISIS ASSISTANCE

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 4: CRISIS ASSISTANCE

Section 5 - WEATHERIZATION ASSISTANCE

Section 5: WEATHERIZATION ASSISTANCE

Section 6 - Outreach, 2605(b)(3) - Assurance 3, 2605(c)(3)(A)

Section 7 - Coordniation, 2605(b)(4) - Assurance 4

Section 7: Coordination, 2605(b)(4) - Assurance 4

Section 8 - Agency Designation,, 2605(b)(6) - Assurance 6

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 8: Agency Designation, 2605(b)(6) - Assurance 6 (Required for state grantees and the Commonwealth of Puerto Rico)

Section 9 - Energy Suppliers,, 2605(b)(7) - Assurance 7

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN

Section 9: Energy Suppliers, 2605(b)(7) - Assurance 7

Section 10 - Program, Fiscal Monitoring, and Audit, 2605(b)(10) - Assurance 10

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) MODEL PLAN SF - 424 - MANDATORY

Section 10: Program, Fiscal Monitoring, and Audit, 2605(b)(10)

Section 11: Timely and Meaningful Public Participation, 2605(b)(12), 2605(C)(2)

Section 12 - Fair Hearings,2605(b)(13) - Assurance 13

Section 13: Reduction of home energy needs, 2605(b)(16) - Assurance 16

Section 14 - Leveraging Incentive Program ,2607A

Section 15 - Training

Section 17 - Program Integrity, 2605(b)(10)

Section 17: Program Integrity, 2605(b)(10)

17.5. Income Verification

17.9. Benefits Policy - Bulk Fuel Vendors

17.10. Investigations and Prosecutions

Section 18: Certification Regarding Debarment, Suspension, and Other Responsibility Matters

Section 18: Certification Regarding Debarment, Suspension, and Other Responsibility Matters

Certification Regarding Debarment, Suspension, Ineligibility an Voluntary Exclusion -- Lower Tier Covered Transactions

Section 19: Certification Regarding Drug-Free Workplace Requirements

Section 19: Certification Regarding Drug-Free Workplace Requirements

Certification Regarding Drug-Free Workplace Requirements

Section 20: Certification Regarding Lobbying

Assurances

Plan Attachments

PLAN ATTACHMENTS

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