Energy Assistance Program
Illinois Department of
Commerce and Economic Opportunity
2016
PROCEDURES MANUAL
July 1, 2015
i
TABLE OF CONTENTS
SECTION IENERGY ASSISTANCE PROGRAM OVERVIEW Page
Purpose ...............................................................................................................I.1
Legislative Background .....................................................................................I.1
Program Design (PIPP, DVP, Cash) ..................................................................I.3
Section I -- Exhibits ...........................................................................................I.6
SECTION II ENERGY ASSISTANCE PROGRAM BENEFITS
Energy Assistance (PIPP, DVP, Cash) ..............................................................II.1
Crisis/Reconnection Assistance .........................................................................II.3
Furnace Assistance Component .........................................................................II.7
Cooling Assistance……………………………………………………………II.15
Section II Exhibits…………………………………………………………..II.16
SECTION III - OUTREACH
Outreach Responsibilities .................................................................................III.1
Outreach Plan ....................................................................................................III.2
Coordination and Referral Procedures ..............................................................III.2
Consumer Education .........................................................................................III.4
Publicity ............................................................................................................III.4
SECTION IV - INTAKE
Intake Strategy ..................................................................................................IV.1
Home Visits/Mail-In Applications ....................................................................IV.2
Special Accommodations..................................................................................IV.3
Locations for Outreach/Intake ..........................................................................IV.3
Scheduling Outreach/Intake ..............................................................................IV.4
Application/Eligibility ......................................................................................IV.4
Authorization to Apply……………………………………………………….IV.4
Client Confidentiality Rights ............................................................................IV.5
Client Appeals Rights .......................................................................................IV.5
Section IV Exhibits ........................................................................................IV.6
SECTION V DOCUMENTATION
Income Documentation.....................................................................................V.1
Multiple Applications.......................................................................................V.2
Zero Income Adult vs. Household....................................................................V.3
Department of Human Services (DHS)........................................................... V.4
Unemployment Compensation (UCB)............................................................ V.6
Interest..............................................................................................................V.6
Self-Employment..............................................................................................V.6
Other Income....................................................................................................V.6
Other Types of Documentation……………………………………………….V.9
Child Custody/Energy Assistance Application……………………………….V.10
ii
Legal Name…………………………………………………………………...V.10
Social Security Numbers……………………………………………………...V.10
Proof of Responsibility for Energy Consumption…………………………….V.11
Goof Faith Effort (GFE)……………………………………………………....V.11
Rent Amount Verification………………………………………………….....V.13
Document Request Form……………………………………………………...V.14
Medical Certification and/or Cooling Medical Condition…………………….V.14
Section V – Exhibits…………………………………………………………..V.15
SECTION VI APPLICATION INSTRUCTIONS
Application Instructions ....................................................................................VI.1
Section VI Exhibits…………………………………………………………VI.12
SECTION VII VERIFICATION, AUTHORIZATION, NOTIFICATION &
PAYMENT
Verification .......................................................................................................VII.1
Reviewing the Application ...............................................................................VII.2
Incomplete Application .....................................................................................VII.2
Assuring All Documentation is Complete ........................................................VII.2
Verification of Income ......................................................................................VII.3
Reconnection Assistance Income Verification .................................................VII.4
Incomplete Documentation ...............................................................................VII.5
Request for Documentation ..............................................................................VII.5
Verification of Utility Account Customer ........................................................VII.5
Verification of Rental Expenses .......................................................................VII.5
Eligibility Determination ..................................................................................VII.6
Payment Authorization .....................................................................................VII.6
Client Notification ............................................................................................VII.6
Vendor Notification ..........................................................................................VII.6
Electronic Vendor Notification .........................................................................VII.7
Energy Assistance Program Payments..............................................................VII.7
Correction of Client Benefit Errors...................................................................VII.8
Transfer of Payments and Refunds from Vendors ............................................VII.9
When Payments Are Sent to DCEO………………………………………….VII.9
Recoupments………………………………………………………………....VII.10
Death of Applicant…………………………………………………………...VII.10
Section VII – Exhibits……………………………………………………….VII.11
SECTION VIII FISCAL PROCEDURES
Cash Requests ...................................................................................................VIII.1
Budget Modifications........................................................................................VIII.1
Budget Flexibility .............................................................................................VIII.1
Formal Budget Modifications ...........................................................................VIII.1
Equipment Purchases ........................................................................................VIII.2
Equipment Disposal…………………………………………………………..VIII.2
Cost Categories/Allowable Expenses ...............................................................VIII.3
iii
Section VIII Exhibits .....................................................................................VIII.5
SECTION IX FILING SYSTEMS
Required Subject File Types ...............................................................................IX.1
Required Subject File Contents………………………………………………..IX.1
Grant Agreement File……………………………………………………….....IX.1
Client File……………………………………………………………………...IX.2
Contents of LIHEAP Client File………………………………………………IX.2
Required Filing Procedures……………………………………………………IX.3
Possible Alternatives for Organizing Client Files……………………………..IX.4
Ineligible Applicants…………………………………………………………..IX.4
Insurance Files…………………………………………………………………IX.5
Personnel File………………………………………………………………….IX.5
Correspondence File…………………………………………………………...IX.5
Regulations File………………………………………………………………..IX.6
Vendor File…………………………………………………………………….IX.6
Record Release and Retention ............................................................................IX.6
Section IX Exhibits…………………………………………………………..IX.8
SECTION X HEARINGS AND APPEALS
Dispute Procedures…………………………………………………………...X.1
Informal Conference .........................................................................................X.1
State Review .....................................................................................................X.2
Formal Hearing .................................................................................................X.2
Section X Exhibits .........................................................................................X.4
SECTION XI REPORTING
Reporting Procedures ........................................................................................XI.1
Reporting Time Frames ....................................................................................XI.1
Reporting Content .............................................................................................XI.1
Vendor Agreement ............................................................................................XI.2
General Agreement…………………………………………………………...XI.2
Securing the Agreement……………………………………………………....XI.2
Section XI Exhibits ........................................................................................XI.3
SECTION XII – DISASTER RECOVERY PLANNING
Disaster Contingency ........................................................................................XII.1
Reporting and Payment .....................................................................................XII.1
Summary ...........................................................................................................XII.2
Section XII Exhibits .......................................................................................XII.3
Page 1 of 2
2016 ENERGY ASSISTANCE PROGRAM
PROCEDURES MANUAL
Overview of Additions, Changes, etc. updated 10/19/15
I
Redundant information was removed from Section I and updated in Section II
All Sections
Made corrections throughout the manual to reflect the suspension of the PIPP.
All Sections
Made corrections throughout the manual to reflect no PY2016 Cooling Program
All Sections
DCEO will no longer be declare an Emergency period
All Sections
Replaced the word Benefit Check to Two Party Check
All Sections
Reconnection Assistance amount reduced from $1,000 to $750
All Sections
Made corrections to indicate GFE/CPR, as clients will now be responsible to pay their
outstanding balance in order to get LIHEAP benefit(s) to help reconnected.
All Sections
No DVP/RA benefits will be provided unless it results in reconnection
All Sections
Corrected program dates, October 1
st
, November 1
st
, and December 1
st
. Furnace is
October 1
st
-March 31
st
. All are until end of program or until funds are exhausted.
I.12
Updated Income Guidelines for 2016
II.4
New 18 hour reconnection assistance definitions, instructions, and requirements
II.7
Continue to document in the file, but to meet the 18/48 hour requirement written
permission is not needed to use a contractor for the assessment. An IHWAP
certified staff member must complete the Final Inspection.
II.8
Added information on when and where Furnace Assistance application data must be
entered into LIHEAP.net. From initial client contact through LAA Paid status the
LAA must make Activity History entries so other LAA staff or GMs will know the
job status at all times.
II.10
Reminder: A Manual J (or equivalent) sizing chart is required for all furnace
replacements.
II.10
The mileage rate has increased to .57 cents per mile
II.11
Added the updated Mechanical Measures and Cost Limits, to align with IHWAP.
II.12
Returned to former policy: The cost of the Health and Safety items needed for the safe
restoration of heat are not included in the cost limit.
II.20
Replaced Benefit Matrices
2016 ENERGY ASSISTANCE PROGRAM PROCEDURES MANUAL
Overview of Additions, Changes, etc.
Page 2 of 2
II.29
Up-dated Applicant File Checklist, which is now an optional form. It is recommended
the LAAs use the OEA checklist or some LAA-developed file checklist.
V.7
Other income, such as income from selling farm crops or livestock or similar
bulk product once a year, must be divided by 12 months to equal the 30 day
income requirement
Commission checks that cover more than one month should be divided by the
appropriate number of months to equal the 30 day income requirement
V.10
LIHEAP HHS Information Memorandum published December 12, 2014 states: The
income of all household members regardless of eligibility must be documented,
verified, and included in the calculation of the LIHEAP benefit amount.
V.14
If the urgency of the application status does not allow for the Documentation Request
form and/or GFE letter to be sent, and the LAA handles the client notification via
phone or in person, then the client contact must be documented in the file and/or in the
LIHEAP.net App Comments section.
V.20
Updated Zero Income Affidavit
V Exhibits
TANF chart revised per DHS table. Group I Adult & Children, # in unit 5 increased
from $552 to $555
VI.21-22
The minor change relates to client authorization for the new HHS Performance
Measures data exchange process between the utilities/vendor and the Department for
the purpose of program evaluation and analysis
VII.8-9
Added new policy regarding “Correction of Client Benefit Errors.”
IX.2
Including the Benefit Summary page in the client file is now optional. However,
when an LAA receives a list of files to be reviewed a final status Benefit Summary
page must be included in the file.
IX.6
New Office of Management and Budget (OMB) Circular Guidance 2 CFR Part 200
(former OMB Circulars A-110, Common Rule, A-87, A-133 and A-122 as applicable)
and OMB Guidance 45 CFR Part 75.
IX.7
Record Retention - Local agencies are to keep program files (LIHEAP and/or PIPP)
for a minimum of four (4) years following the Department’s final written approval of
all required close-outs or until that program year’s audit is finally resolved, unless the
Department notifies the LAA prior to the expiration of the for years that a longer
period is required Records may be kept electronically.
SECTION I
ENERGY ASSISTANCE PROGRAM OVERVIEW
SECTION IENERGY ASSISTANCE PROGRAM OVERVIEW
Purpose ..............................................................................................................I.1
Legislative Background ....................................................................................I.1
Program Design ................................................................................................I.3
Section I -- Exhibits ..........................................................................................I.6
I.1
SECTION I
ENERGY ASSISTANCE PROGRAM OVERVIEW
Purpose
The primary purpose of the Energy Assistance Program is to assist low-income citizens by
offsetting the rising cost of home energy through direct financial assistance, energy counseling,
outreach and education. The program allows the State of Illinois to reach not only the
increasingly vulnerable low-income population, but also to serve as an important entry point
for a variety of other needed social services for the low-income population.
While the energy bills a low-income family incurs may not be higher than that of the average
family, their relative poverty means it takes a larger percentage of their income to pay them.
Thus, while the average family pays approximately 5% of their income toward their energy
bills, a low-income family may pay 33% or more of their income toward their energy bills in
the absence of any energy assistance.
Legislative Background
The Low-Income Home Energy Assistance Act of 1981 (Title XXVI of the Omnibus Budget
Reconciliation Act of 1981, Public Law 97-35), as amended in 2005 by Subtitle B of the
Energy Policy Act of 2005 (Public Law 109-58), created the Low Income Home Energy
Assistance Act of 1981. Under this Act, the Secretary of the U.S. Department of Health and
Human Services (HHS) is authorized to make grants to states to assist low-income
households in meeting the costs of energy consumed for heating and, where medically
necessary, cooling of residences. States must comply with sixteen assurances prior to receipt
of funds:
1. How the Energy Assistance Program funding will be used
2. Which client eligibility criteria will be implemented
3. How outreach efforts will be conducted
4. How Energy Assistance Program activities will be coordinated with similar &
related Federal programs
5. What benefit payment levels will be established for the Energy Assistance
Program
6. How local administering agencies are designated and procedures followed to
choose a successor agency to operate the Energy Assistance Program
7. How payments will be made to vendors
8. How the State will assure that low-income clients will have equal access to the
Energy Assistance Program
9. How administrative costs will be used
10. How the State will ensure that fiscal accountability will be maintained and audits
will be conducted
11. Agree to cooperate with federal investigations
I.2
12. How the general public will be given the opportunity to review and comment on
the Energy Assistance Program design
13. What rights will be given to the client, and how appeal procedures will be
established
14. What policies will be established for nondiscrimination, tracking energy usage,
funding allocation, and reporting
15. How statewide outreach and intake efforts will be coordinated
16. How the State will provide services that encourage households to reduce their
home energy needs
These assurances are designed to ensure minimum and basic continuity of program design
among states. However, the Act does allow states flexibility to develop and implement plans
that meet their own diverse needs and circumstance.
The Energy Assistance Act of 1989, as amended, details the specifics of the Energy Assistance
Program (the original Low Income Home Energy Assistance Program, or LIHEAP). In July of
1991, the Illinois General Assembly amended the Illinois Energy Assistance Act of 1989
establishing a low-income energy assistance policy and a program that incorporates fuel
assistance, home weatherization and other measures designed to more effectively assist eligible
households to meet home energy costs. In January of 1998, Public Act 90-561, the Electric
Service Customer Choice and Rate Relief Law of 1997, was signed into law. This law adds an
additional funding source for the Illinois Energy Assistance Program.
There are several major differences in the utilization of the State funds as compared to the
Federal HHS funding. The restrictions on State funding are:
1. Furnace Assistance work is not allowed; therefore all furnace work must be done
with Federal funds.
2. Cash payments are not allowed; therefore all cash payments must be made with
Federal funds.
3. Payments to delivered fuel (propane, fuel oil, woods, etc.) vendors are not
allowed; and, therefore all delivered fuel payments must be made with Federal
funds.
4. Payments to Rural Electric Cooperatives (REAs) or Municipal Utilities may not
be made unless the entity has agreed to participate in the program and collect the
monthly meter charge.
5. Benefits are designated as heat-related only.
The Energy Assistance Act was amended in July of 2002 to require the Department to ensure
that a disproportionate share of available Federal funds is not provided to customers of
municipal and rural electric cooperative utilities who do not assess the charges outlined in the
Act. Total Federal benefits provided to all such utilities in any given county are, therefore,
limited to the percentage of Federal funds received by all such utilities in each county during
the years prior to the 1998 program year applied to the current Federal county allocation. This
limitation applies to the total of all Energy Assistance Program benefit types, excluding
emergency periods. When the limit is reached, further applicant households will be denied.
I.3
In July of 2009, Public Act 96-33, the Illinois General Assembly amended the Energy
Assistance Act (305 ILCS 20) and added the Percentage of Income Payment Plan (PIPP) as
an option for the Energy Assistance Program for eligible residential customers. Section
18(c)(8) requires PIPP to be operational on September 1, 2011. The PIPP will:
1- Bring participants’ gas and electric bills into the range of affordability;
2- Provide incentives for participants to make timely payments;
3- Encourage participants to reduce usage and participate in conservation and energy
efficiency measures that reduce the customer’s bill and payment requirements; and,
4- Identify participants whose homes are most in need of weatherization.
Program DesignEnergy Assistance
According to funding availability, local agencies will offer three types of assistance:
1. Percentage of Income Payment Plan (PIPP): (Temporarily Suspended) The main
objective of the PIPP is to make energy bills more affordable and to help maintain home
energy service throughout the year. The PIPP will help reduce bills only if participants
make the required full, on-time monthly payments. By enrolling in the PIPP, the
household has agreed to enter into a monthly budget payment plan with the participating
utility. The utility will reduce the account’s pre-program arrearage, for each on-time
monthly payment made by the bill due date, up to a total of $1,000 for the program year.
2. Cash Assistance - Applicant households who:
1. indirectly purchase energy as an undesignated portion of rent, or
2. are public housing authority tenants whose lease contains a “subject to
surcharge” clause
will be eligible to receive assistance in the form of a one-time cash payment made
directly to the household if the applicant’s rental expenses are greater than 30% of
the household’s gross income. The Payment Matrices will be used to determine
assistance levels. These payments will vary by the household’s size, income and
geographic location within the state.
3. Direct Vendor Payments - Applicant households that purchase energy directly from
vendors are eligible to receive energy assistance benefits in the form of a one-time
payment made directly to the applicable vendor (Direct Vendor Payment or DVP)
representing a percentage of the average primary and secondary bills for the winter
months, October through May. The Payment Matrices are based on a percentage of
those average energy costs. These matrices will be used to determine assistance levels,
which vary by household income, fuel type, family size, and geographic location.
Benefits to these households will be split between primary and secondary vendors in
accordance with the payment matrix. Secondary electric service must be an integral part
of the heating system in order to qualify for a benefit.
I.4
A. Crisis Assistance/Reconnection Assistance (RA): The Illinois Department of
Commerce and Economic Opportunity may set aside a portion of the State’s
allocation for use in emergency situations. Under this component, funds may be used
for either weather or other emergencies that affect the entire eligible population or
for emergency-related situations that affect an individual household to the extent
funds are available.
In the event of a weather-related natural disaster or extreme weather conditions, the
Illinois Department of Commerce and Economic Opportunity will develop an
appropriate response designed to eliminate the threat to life and health. Under such
conditions, the Department may utilize a portion of current program year Energy
Assistance Program funding to provide assistance to low-income households
affected by the extreme weather condition. This assistance will be limited to energy-
related crisis activities, such as pledges of payment to utilities, replacement of fuel
tanks, heating system and water heater repair, purchase of fans, operation or support
of local cooling centers, coordination with local social service agencies, air
conditioners (where medically necessary), etc.
Energy assistance will be offered starting on October 1, 2015, and will continue to be
available through May 31, 2016 or until the funding is exhausted.
B. Furnace Assistance: Furnace benefits, which include repair, or replacement, will be
utilized to restore a vital heat supply to the home. It will be operated by Local
Administering Agencies weatherization program (see Local Administering
Agencies map in Section II), which are uniquely situated to define and develop
individualized responses to energy-related emergencies and emergency furnace
repair to restore a home heating source.
C. Cooling: At the discretion of the Department, cooling assistance may be offered
during the summer months to eligible at-risk households, such as households with a
person who is elderly and/or has a disability, households containing a child under 6
years of age, or households with a documented medical condition.
Two Priority Groups will be served during the priority period of October and
November:
1. Priority Group I includes households with a person who is elderly and/or has a
disability, and begins October 1. The Priority Group I households without home
energy service (are disconnected or under imminent threat of disconnection from their
primary and/or secondary energy source) may be served beginning October 1 with
Reconnection Assistance including Furnace Assistance applications (the first criterion
for Furnace Assistance is: there must be an Approved DVP application before a Furnace
application may be completed).
I.5
2. Priority Group II - includes families with children under the age of 6 years, and
disconnected households, and begins November 1. The Priority Group II
households without home energy service (are disconnected or under imminent threat of
disconnection from their primary and/or secondary energy source) may be served
beginning November 1 with Reconnection Assistance including Furnace Assistance
applications (the first criterion for Furnace Assistance is: there must be an Approved
DVP application before a Furnace application may be completed).
Beginning December 1 all program benefits will be available to all eligible low-income
households. Applications will be taken through May 31 or until funding is depleted, whichever
comes first.
Eligibility for the Energy Assistance Program is limited to applicant households (defined in
Exhibit I.9) at or below 150% of the federal poverty income level. Income guidelines (Exhibit
I.12) are based on the household’s gross income for 30 days, beginning with the date of
application.
In accordance with the Energy Assistance Act (305 ILCS 20), as amended, the Department
will set aside an amount of up to 33% of the total funding for client payments to be used for
households that receive Temporary Assistance for Needy Families (TANF); Aid to the Aged,
Blind and Disabled (AABD); and households at or below 50% of the poverty level.
SECTION I
ENERGY ASSISTANCE PROGRAM OVERVIEW
EXHIBITS
Energy Assistance Program Design Flow Chart ........................ I.6
Applicant Household Definition and Determination .................. I.7-9
Determination ........................................................................... I.9
Income Guidelines ...................................................................... I.10
LAA Energy Assistance Program Time Frames.. ...................... I.11
LIHEAP DESIGN:
Moving the Client Through
The Eligibility Process
No
Yes
No No
Yes Yes
Is monthly rent
greater than 30%
of income?
Issue
Denial
Letter
Does household pay
own bills?
Is household income
eligible?
No
Yes
Yes
No
GFE&35 Met?
Is household
disconnected or
imminent threat?
Renter Household
Receives Cash
Assistance
Notification to
Household of
Eligibility
Issue denial
letter for RA &
DVP
DVP: Issue Assistance
to Utility on
household’s behalf
$$ issued to
Household
Notification to
Household of
eligibility
Notification to Utility of
assistance to be provided
on household’s behalf
$$ issued to
Utility
I.6
I.7
APPLICANT HOUSEHOLD
Definitions
1) Household is defined as an individual(s) living in private living quarters (a space
with a private entrance, kitchen and bathroom facilities) for which residential heat
is purchased in common. An individual room within a primary residence does not
qualify.
2) Applicant: Every individual in the household is an applicant. Each applicant
must be a legal resident of Illinois and either a citizen of the United States or a
qualified alien.
A qualified alien is a non-citizen whose status (at the time the client
applies for, receives, or attempts to receive a Federal public benefit) on
the date of their entry into the U.S. is listed below:
• Lawfully admitted permanent resident (LPR) under the Immigration
and Nationality Act (INA);
Exception: Permanent Residents previously admitted under a status in
the Refugee group, have eligibility determined the same way as the
Refugee’s group without regard to work quarters.
Asylee granted such status under section 208 of the INA;
Refugee admitted to the U.S. under section 207 of the INA;
Exception: Non-citizens who have been certified as a victim of
trafficking by the Office of Refugee Resettlement (ORR), have
eligibility determined in the same way as Refugees, without regard to
qualified alien status. See Section 305.13, Qualified Aliens Eligible
Without Restriction .
Non-citizen whose deportation is being withheld under section 243(h)
of the INA (Note: after April 1, 1997, withholding of deportation is
under section 241(b)(3));
Parolee paroled into the U.S. under section 212(d)(5) of the INA for a
period of at least 1 year;
Conditional entrant into the U.S. under section 203(a)(7) of the INA as
in effect prior to April 1, 1980;
Cuban or Haitian entrant under section 501(e) of the Refugee
Education Assistance Act of 1980;
Amerasian immigrant under section 584 of the Foreign Operations,
Export Financing, and Related Programs Appropriations Act of 1988
(usually the children of Vietnamese women and Americans present in
Vietnam during the Vietnam War era); or
• a battered immigrant spouse, battered immigrant child, immigrant
parent of a battered child or an immigrant child of a battered parent:
I.8
- with a petition pending under 204(a)(1)(A) or (B) or 244(a)(3) of the
INA;
- who is no longer living in the same household as the abuser; and
- who can establish a connection between the battery and the need for
SNAP benefits. Examples include, but are not limited to, the following
situations in which benefits are needed: to enable the applicant to
become self-sufficient, to escape the abuser to ensure the safety of the
applicant, because the applicant has lost financial support or his or her
home in leaving the abuser, or because of a disability that was a result of
the abuse.
If an alien refuses to document their status, they are ineligible. United States
citizenship will be documented by applicant’s statement.
Qualified alien status must be documented by one of the following:
1) Immigration and Naturalization Service (INS) form I-551 (Permanent
Resident card) or 151 (Alien Registration Receipt Card).
2) Reentry Permit (a passport booklet for lawful permanent resident
aliens).
3) INS Form I-94, arrival and departure record. This form must be
annotated with one of the following terms or a combination of terms:
refugee, parolee, paroled, asylum, annotated with 204, 207, 208,
212(d) (5), 243 (h), or 244 of the INS Act.
4) INS Form I-688. This form must be annotated with a reference to
section 210 (a) of the Immigration and Naturality Act. Note: Form I-
688A or B is not acceptable.
5) Violence Against Women’s Act applicant needs a I-797 receipt in
order to show eligibility (to prove VAWA beneficiary)
6) An I-360 Violence Against Women’s Act self-petition (to prove
VAWA beneficiary).
7) Refugee Travel Document (INS Form I-571) as proof of status for
refugees.
3) Elderly: An applicant or household member age 60 or above is considered
elderly, and the household is eligible to apply for benefits during the priority
period.
4) Disabled: An applicant (any household member) is considered to be disabled
for the purposes of the Energy Assistance Program and eligible to apply for
benefits during the priority period if he or she is: determined to be totally and
permanently disabled or blind by a governmental entity or medical
professional and receiving or has been approved for Federal Social Security
Disability benefits, Civil Service Disability or Federal Supplemental Security
Income benefits based on blindness or disability, Veterans Administration
Disability benefits, Railroad Retirement Disability benefits, or any State
Pension or payment based on blindness or disability.
I.9
Documentation may include the following sources: receipt of Supplemental
Security Income (SSI), receipt of Social Security Disability (under age 62
with social security number followed by claim letter A, HA, W, or C, if adult
child), an award letter stating permanent and total disability, a Veterans
Administration disability award letter, Medicare Card, or a bank statement
indicating any household member receives SSI.
Determination
Eligibility is based on all individuals living together at the time of application. This
includes individuals who are only away from the home due to employment such as
truck drivers and salesmen.
Individuals meeting or living under the following conditions will be considered
ineligible:
1. Individuals living in professional, practical or domiciliary nursing or boarding
homes who do not pay a home energy supplier directly for heating costs.
2. Individuals residing in hotels, motels, dormitories or temporary shelters who
do not pay a home energy supplier directly for heating costs.
3. Individuals living in government subsidized housing unless they are paying a
home energy supplier directly for their heating costs or are billed for any out-
of-pocket heating costs by the landlord or housing authority.
4. Individuals who are incarcerated.
5. Students or military personnel who are not actually living in the home.
6. Individuals defined as roomers, boarders or live-in attendants.
Roomer/boarder is defined as an individual living in the household who
receives wages to provide medical/child care and who is not responsible for
any household expenses.
7. Passenger vehicles (cars, trucks, vans) are not considered permanent
structures and are ineligible for energy assistance.
I.10
ENERGY ASSISTANCE PROGRAM
2016 INCOME GUIDELINES
Family
Size
150%
30 Day Income
150%
Annual Income
1
$1,471
$17,655
2
$1,991
$23,895
3
$2,511
$30,135
4
$3,031
$36,375
5
$3,551
$42,615
6
$4,071
$48,855
7
$4,591
$55,095
8
$5,111
$61,335
9
$5,631
$67,575
10
$6,151
$73,815
11
$6,671
$80,055
12
$7,191
$86,295
13
$7,711
$92,535
14
$8,231
$98,775
15
$8,751
$105,015
16
$9,271
$111,255
17
$9,791
$117,495
18
$10,311
$123,735
For families with more than 18 persons, add $520 for each additional person. $6,240
These figures are based on the 2014 Federal Poverty Guidelines published in the US Department of Health
and Human Services in the Federal Register/Volume 80/Number 14/January 22, 2015. The state reserves
the right to adjust these levels based on the availability of federal appropriations.
I.11
LAA ENERGY ASSISSTANCE PROGRAM TIMEFRAMES
PROCESS CALENDAR DAYS
A. INTAKE
If an appointment system is used
Home Visits
Appointment must be given within
60 calendar
days of the date it is requested.
When a home visit is determined necessary, the
client who is in need of the home visit must be
served within
60 calendar days from the date of
request.
B. TAKING THE APPLICATION
Application Taken/Documentation Collected
Denial (Lack of Information)
Option to reverse a Denial due to delay in
collection of information (within 90 days
from application date)
1
-15 days (or appropriate program end deadline)
Between the 16
th
and 30
th
day from the date of
application.
Between the 16
th
and 90
th
day from the date of
application.
C. DETERMINATION AND NOTIFICATION
(Written/Verbal)
Energy Assistance Applicants
Reconnection Assistance Applicants and
Energy Assistance Program
Furnace Assistance
1
– 30 days from the date of the complete
applicant’s file (all information is in the file, date
received indicated).
48 hours from the date that the applicant’s file is
complete
and determined eligible (all
information
is in the file, date received indicated).
18 hours from the date that the applicant’s file is
complete
and determined eligible
if energy crisis
is life threatening.
D. PAYMENT
To the client or vendors
Within 15 days of the date the register is
returned (contingent upon availability of funds).
SECTION II
ENERGY ASSISTANCE PROGRAM BENEFITS
SECTION II ENERGY ASSISTANCE PROGRAM BENEFITS
Energy Assistance .............................................................................................II.1
Crisis/Reconnection Assistance ........................................................................II.3
Furnace Assistance Component ........................................................................II.7
Cooling Assistance............................................................................................II.15
Section II Exhibits..........................................................................................II.16
II.1
SECTION II
ENERGY ASSISTANCE PROGRAM BENEFITS
In compliance with Senate Bill 1918 and the Illinois Energy Assistance Act of 1989, as
amended, and to ensure that households having the lowest income receive an appropriate
portion of the statewide funding, an amount not less than 33% of the total LIHEAP funds for
benefits is available to serve households eligible for public assistance; e.g., those receiving
TANF, AABD or with incomes at or below 50% of the poverty level.
All applicants eligible for assistance under the bill payment assistance program will have the
choice to apply for the Percentage of Income Payment Plan (PIPP) program, or the traditional
Low Income Home Energy Assistance Program (LIHEAP).
ENERGY ASSISTANCE
Option 1: Percentage of Income Payment Plan (Currently Suspended)
The main objective of the PIPP is to make energy bills more affordable and to help maintain
home energy service throughout the year. The PIPP will help reduce bills only if participants
make the required full monthly payments. By enrolling in the PIPP, the household has agreed to
enter into a monthly budget payment plan with the participating utility. The utility will reduce
the account’s pre-program arrearage, for each on-time monthly payment made by the bill due
date, up to a total of $1,000 for the program year.
Participants are responsible for monthly payments toward their energy bills that are based on a
percentage of their total household income and are also responsible for any outstanding balance
on their account that cannot be addressed by the monthly State/DCEO Benefit. The State will
pay an amount not to exceed $1,800 (a maximum of $150/month) for all electric customers or
$1,200 (a maximum of $100/month) for Gas primary customers in any twelve (12) month period.
In addition, if the PIPP client obtains their secondary electric service from a PIPP-participating
vendor, they can also elect to participate in the PIPP with that vendor as well. In this instance,
DCEO will pay on behalf of the household a monthly benefit amount
not to exceed $600 (a
maximum of $50/month) for secondary electric customers in any twelve (12) month period.
Participant failure to make the required full monthly payments by the due date every month may
result in termination from the program, and they will not be eligible for the regular LIHEAP
program Direct Vendor Payment (DVP) until the next program year. Household income will
need to be recertified at least once a year in order to continue to be eligible and receive assistance
through the PIPP. Households with no income source will be reverified on a quarterly basis
(every three months).
There is a 12-month certification period for PIPP participants, unless other circumstance
should necessitate a lesser period of active participation (for example, moving to a non-PIPP
utility service area, being dropped for non-payment, etc.). Prior to the end of the
certification period, the head of household must schedule an appointment with the Local
II.2
Administering Agency (LAA) to recertify participation in the Statewide PIPP for the next
program year.
Option 2: Cash Assistance
Applicant households who:
1. indirectly purchase energy as an undesignated portion of rent, or
2. are public housing authority tenants whose lease contains a “subject to
surcharge” clause
will be eligible to receive assistance in the form of a one-time cash payment made directly to
the household if the applicant’s rental expenses are greater than 30% of the household’s gross
income. The Payment Matrices will be used to determine assistance levels. These payments
will vary by the household’s size, income and geographic location within the state.
Option 3: Direct Vendor Payments
Applicant households that purchase energy directly from vendors are eligible to receive energy
assistance benefits in the form of a one-time payment made directly to the applicable vendor
(Direct Vendor Payment or hereafter referred to as a “DVP”) representing a percentage of the
average primary and secondary bills for the winter months, October through May. The Payment
Matrices are based on a percentage of the average energy costs for those months. These matrices
will be used to determine assistance levels, which vary by household income, fuel type, family
size, and geographic location. Benefits to these households will be split between primary and
secondary vendors in accordance with the payment matrix. Secondary electric service must be
an integral part of the heating system in order to qualify for a benefit.
In order to receive a DVP, the energy vendor must agree to comply with 47 Illinois
Administrative Code Part 100 and sign a Vendor Agreement. If a particular household’s
vendor does not agree to the provisions of the vendor agreement, the Local Administering
Agency will attempt to find an alternate vendor, or issue a two-party check payable to either
the applicant or to the original vendor.
In accordance with the Payment Matrices, DVPs for those shall be made as follows:
If the energy vendor has signed a Vendor Agreement and provides both primary and
secondary service (heat-related) to an applicant, then the vendor will receive, on
behalf of the applicant, a total of the primary and secondary payment as listed in the
Payment Matrix.
If the primary and secondary vendors have both signed, they will receive the
appropriate payments on behalf of the applicant as listed in the Payment Matrix.
II.3
If the primary vendor has signed but the secondary vendor has not, then the primary
payment will be sent to the primary vendor and the secondary payment shall be sent
in the form of a two-party check to either the applicant or the vendor.
If the secondary vendor has signed but the primary vendor has not, then the secondary
payment will be sent to the secondary vendor and the primary payment shall be sent
in the form of a two-party check to either the applicant or the vendor.
If neither the primary nor secondary vendor has signed, then the local agency will
attempt to find an alternate energy vendor(s). If no alternate vendor(s) are found,
then the primary and secondary payments as listed in the Payment Matrix must be
sent in the form of a two-party check to either the applicant or the vendor(s).
If the applicant has only primary energy service (no secondary) then only the primary
payment as listed in the Payment Matrix will be made to the vendor on behalf of the
applicant. If the vendor is unsigned, the payment must be sent in the form of a
benefit check to either the applicant or the vendor.
Households will only be allowed to receive Energy Assistance (one DVP per eligible utility
or Cash) one time per program year. A household that initially receives a Cash payment may
not return to apply for a DVP or Reconnection Assistance at a later date if their
energy/housing situation changes. A member of a household who receives a benefit may not
be served again, either as head of household or counted as a member of another household.
A. Crisis Assistance/Reconnection Assistance
Reconnection Assistance (RA) will be offered:
October 1 only for applicants with an elderly household member (age 60 or older) or
with a disabled household member (who are disconnected or under imminent threat of
disconnection from their primary and/or secondary energy source); and/or
November 1 for households without home energy service (disconnected or under
imminent threat of disconnection from their primary and/or secondary energy source)
and to households that contain children age 5 years or under (include all children who
are not yet 6 years old, that is, up to 5 years and 364 days old) as of the date of
application; and
December 1 to all low-income households, including households who are under
imminent threat of disconnection. Reconnection Assistance is designed to help
households obtain a continuous supply of home energy with expedited processing.
RA benefits will be provided to those eligible households that apply for Energy
Assistance and are disconnected or are in imminent threat of disconnection.
Imminent Disconnection means the utility has planned the disconnection to occur
within seven (7) days. However, as in previous years, energy services must be
broken down by type of charge for households that are charged with meter tampering
or theft of service. The agency must separate costs of disconnection from costs
incurred after disconnection (e.g., tampering, theft, etc.). Only non-theft usage will
II.4
be paid with Energy Assistance Program funding. No RA payments are to be made to
energy vendors until a verified reconnection date has been established.
Reconnection costs include required deposits, setup fees and reconnect or “hookup”
charges. Energy Assistance Program funds do not include charges for theft of service or
tampering. For the purpose of households that utilize delivered fuel (propane, fuel oil,
coal, etc.) a disconnection or imminent threat occurs when the delivered fuel supplier
refuses to deliver and the fuel supply is less than or equal to 25% of the total delivered
fuel storage capacity. Households that heat with hot water or steam systems are eligible
to receive RA for disconnected water service.
Within the timeframes established by application priority group status, Reconnection
Assistance (RA) will be provided within 48 hours from the date and time the client’s
application is complete (all client documentation has been submitted and verified).
Reconnection Assistance will be provided within 18 hours from the date and time the
client’s application is complete if the energy crisis is life-threatening.
For the purpose of implementing the 18-hour processing provision, a life threatening
situation exists if the following conditions are met:
The temperature is 32
°
Fahrenheit or below
The household is not protected by Illinois Commerce Commission (ICC) rules or
similar local laws.
Reconnection is the only available remedy; i.e., the household does not have
alternate shelter, lacks a safe temporary means of heat or is homebound.
Each agency is required to develop specific written procedures to implement the 18-hour
provision in an equitable manner, including from which source the outside temperature
will be established (e.g., via Intellicast.com for the client’s city of residence). The
temperature must be documented in the App Comments on LIHEAP.net, and it must also
be written in the upper right-hand corner of the printed client application.
Before attempting to utilize emergency funding, the LAA should try to first use a DVP to
secure energy service. If the DVP is not sufficient to reconnect the household, then a
combination of the DVP and RA funding can be used. RA funding can only be used if it
results in a reconnection of the household’s energy service. In the event RA funding is
not sufficient to reconnect the energy service, a DVP will not be made to reduce the total
amount owed by the household.
The amount of Reconnection Assistance will be the minimum amount needed to help
secure energy service to the household. Households are eligible for emergency payments
not to exceed a TOTAL of $750 per household per year. Eligible households are limited
to one Reconnection Assistance payment for the primary energy source and one for the
secondary. Both payments combined cannot exceed the applicable benefit limit.
Applications for primary and secondary emergency payments do not have to be done
simultaneously. The household is allowed to apply for emergency payment to one
vendor and then, if the need exists, return to the LAA at a later date and apply for an
II.5
emergency benefit to the other vendor. This is not to be interpreted to mean that the
household is entitled to the maximum benefit. The time of the application and the
availability of funding will determine if each household applying for emergency benefits
will receive the maximum.
Good Faith Effort
To be eligible for Energy Assistance (DVP and/or RA), a disconnected or imminently
threatened client must make a Good Faith Effort toward paying his/her utility bill(s),
including payment of all Client Portion Required balances.
If the applicant’s payment history does not demonstrate good faith, the applicant will be
required to pay a $75 Good Faith Effort (GFE) payment to the utility or utilities that
would receive LIHEAP payments(s). Applicants may owe additional past due amounts
above the required $75; this balance is the Client Portion Required (CPR). All GFE/CPR
payments must be made in full prior to receiving any Energy Assistance benefit (DVP or
RA).
The Department of Commerce and Economic Opportunity will implement the Good Faith
Effort (GFE) /Client Portion Required (CPR) requirement as follows:
DCEO and/or the LAA will look at the LIHEAP applicant’s payment history. If the
application includes both utilities or if the electric utility is the primary vendor, then the
client payments to vendor(s) in the previous 90 days (beginning with the application date)
must be at least 10% of the 30-day household gross income multiplied by 3. If the
payment history does not demonstrate the required percentage of payments has been
made, then the applicant will be required to pay a GFE and/or CPR.
The preferred method of payment for the $75 is cash or money order at the utility’s
authorized payment center, however receipts from other forms of payment should also be
accepted. If the applicant presents a receipt to verify his/her GFE/CPR payment, the
LAA will enter/save into LIHEAP.net: 1. the total amount paid, 2. the receipt
number/transaction number and date of the payment. The LAA will then continue
processing the application. Or, if a utility reports through LIHEAP.net that the GFE/CPR
payment has been made, the LAA can continue processing the application. The LAA
must enter the exact payment amount made by the client towards their GFE/CPR, instead
of entering only $75. LAAs must negotiate the restoration of service as much as
possible. Regulated utilities are required to comply with the Illinois Public Utilities Act
as amended (Illinois Administrative Code 280) regarding reconnection of service to
Energy Assistance Program households.
IMPORTANT NOTES:
1. If the utility has put the client’s deposit refund onto the final account - this is money
that would go back to the client, if they were still in good standing with the utility. If
the utility will agree to transfer the deposit amount onto the new, or reconnected
account, this may be used to satisfy the GFE/CPR payment requirement. The entire
II.6
amount of the deposit refund payment must be counted as the GFE/CPR payment
(i.e., if the refund is $250, that’s the GFE payment amount, not $75).
2. No GFE/CPR payment receipt should be dated prior to the application date.
At the discretion of the LAA, a client phone call to the LAA with the GFE/CPR
receipt number is acceptable, especially for electronically communicating utilities.
The applicant has 15 calendar days from the GFE/CPR notice to pay the required amount
or be subject to denial after the appropriate deadline (or will be denied if funds are
exhausted, whichever is sooner). A procedure letter to the LAAs in April or May of each
year will establish the last date LAAs may accept missing documentation at the end of
the program year (15 days may be shortened, due to other program year close-out
requirements).
The Good Faith Effort may be waived with written permission from the Office of
Energy Assistance only in cases of extreme economic hardship, or when the applicant
did not have any previous primary and/or secondary service accounts during the past
90 days (starting with the application date) or has paid such bills in full. Extreme
economic hardship exists when the household’s source of income (that income that
would have been used to determine income eligibility) has been permanently
terminated for at least 30 days and a new source of income has not commenced.
Documentation of this condition must be received and verified by the agency before
the Reconnection Assistance payment may be processed. The GFE may be waived in
these specific instances; the CPR may never be waived. The client should make other
arrangements for payment of the CPR.
In summary, the Energy Assistance Program Reconnection Assistance specifics are:
The household must be disconnected or in imminent threat of disconnection or
a verified threat of disconnection with a medical certificate.
A “Does not pay own bills” household is not eligible for RA Assistance.
RA must be provided in 48 hours; if life-threatening, assistance must be
provided within 18 hours.
A DVP should be used first to attempt reconnection. If not successful, a
combination of DVP and Reconnection Assistance can be used. LAAs are to
negotiate as much as possible the reconnection of energy service. An RA
payment is not to be made if it does not result in reconnection. A DVP is not
to be made if it does not result in reconnection in combination with an RA.
Only one primary and/or secondary RA payment per year.
A Reconnection Assistance payment is the minimum amount needed to
secure winter energy services.
The total amount of emergency benefit any one household can receive in a
program year is $750.
Failure to make GFE/CPR payments will result in a denial of benefits.
II.7
If the household is required to make a GFE/CPR, then the household will be
allowed at least 15 days to make the payment(s) (or the appropriate deadline
at the end of the program year, or until funds are exhausted, whichever is
sooner).
Emergency funds cannot be used for tampering, or theft of service.
Tampering charges must be paid by the household separate, and in addition to,
good faith payment.
If the vendor is unsigned, send the payment in the form of a two-party check
to either the applicant or directly to the vendor.
Regulated utilities are required to comply with the Illinois Public Utilities Act
as amended (Illinois Administrative Code 280) regarding reconnection of
service to Energy Assistance Program households.
B. Furnace Assistance Component
The State of Illinois Low Income Home Energy Assistance Program includes a Furnace
Assistance benefit program – the Furnace Assistance Component (FAC). An LAA’s Energy
Assistance staff takes the application, determines eligibility and verifies the benefit. The LAA’s
IHWAP staff conducts a heating system assessment and delivers the Furnace Assistance
Component benefit.
If the heating system cannot be repaired or replaced within the 18/48-hours, the LAA will make
alternative arrangements for temporary heat or relocation of the household (friend or relative’s
home, shelter, etc.) to a temporary location. Each agency is required to develop specific
written procedures to implement this emergency provision in an equitable manner.
Funds allocated to the Furnace Assistance Component of the program are allocated 2.5% of the
Federal Direct Client Assistance cost category 0201, and this limit will be monitored by the
LIHEAP.net system. The Furnace Assistance benefit will only be available to approved Energy
Assistance households that receive a LIHEAP (or PIPP, when available) benefit and whose
existing heating systems are not operational or have been red-tagged by their utility company.
There is NO IHWAP SIR Requirement for Furnace Assistance. If the home doesn’t have an
existing heating system neither LIHEAP nor PIPP funds can be used to install a new heating
system.
To receive Furnace Assistance, the applicant must have an approved Energy Assistance
application. A Good Faith Effort (GFE) or Client Portion Required (CPR) payment is not
required for receiving the heating system portion of Energy Assistance benefits. However, when
a GFE/CPR is required for restoration of utility service no heating system repair or replacement
work will be allowed on that unit until the GFE/CPR is paid and utility service restored. For
example, if a client is disconnected from utility service and the heating system is also red-tagged,
then the standard GFE might still apply to get the service reconnected before the furnace work
would be done. However, if the client has a non-working furnace but is still connected to the
utility service, then a GFE/CPR payment might not be required.
II.8
If the utility service is not restored (e.g., too much is owed, no GFE/CPR is made, etc.), no
heating system work will be allowed on that unit. The utility should be contacted to ensure the
household is not disconnected for nonpayment or other reasons prior to initiating the Furnace
Assistance Component benefits.
The Furnace Assistance Component will be entered on the LIHEAP.net system. On the Furnace
Assistance date of application, the LAA must note client information on:
a. Client Information and Furnace Assessment Worksheet (form)
b. App Comments on LIHEAP.net
c. Furnace section on LIHEAP.net and enter date of application in the activity section:
During the dates the furnace job progresses (from initial client contact through LAA Paid status)
the LAA must make Activity History entries, so other LAA staff or GMs will know the job status
at all times.
The Furnace Assistance Component will only be operated from October 1
st
through March 31
st
no Furnace Assistance applications should be taken after March 31
st
or before October 1
st
. The
goal of this component is to restore the heating system to safe and effective operation. In some
cases, simple repair such as a replacement fuse or thermostat may be all that is needed to restore
heat. Other repairs may be more extensive, requiring the replacement of gas valves, electronic
controls, blower motors, etc.
A heating system may be replaced if the existing system is unsafe or the repairs exceed 50% of
the cost of a new unit. If the Assessor and contractor (including LAAs who use weatherization
crews instead of contractors) determine the furnace must be replaced, the file must contain the
Furnace Replacement Justification Form with the contractor’s (or LAA crew member’s) written
affirmation of needed repairs vs. the new furnace costs to compare and validate repairs exceed
the 50% requirement; this must also coincide with the itemized invoice. If the costs of the
replacement heating system exceed the IHWAP Mechanical cost limits, then a waiver from OEA
Weatherization is required. Any work completed exceeding the mechanical cost limits that does
not have prior authorization from OEA is considered a disallowed cost.
This component is for homeowners or income-eligible landlords residing in their rental property.
Since landlords have a legal responsibility to provide heat to their tenants during the winter
months, renters are not eligible.
Home Ownership and Household Eligibility Documentation Examples:
Example 1: An adult daughter’s name is on a mother’s proof of ownership, but the
daughter does not live in the home, according to the applicant.
1. The LAA must obtain proof the daughter is not in the home (signed, dated
statement from mother and daughter: an official document showing daughter’s
current address, etc.).
II.9
2. The daughter must also complete a Building Owner Certification and Work
Authorization form.
3. If proof of residency and/or Building Owner Certification and Work
Authorization form are difficult to obtain, LAA must document that all possible
efforts toward establishing Energy Assistance household residents.
Example 2: A living spouse’s (or ex-spouse’s) name is on the proof of ownership, but
the (ex-spouse) according to the applicant is no longer in the home:
1. The LAA must obtain proof the spouse/ex-spouse is not in the home (signed,
dated statement from applicant and non-resident spouse/ex-spouse; some official
document showing spouse/ex-spouse’s current address and/or legal
separation/divorce papers, etc.).
2. Have the spouse/ex-spouse complete a Building Owner Certification and Work
Authorization form.
3. If proof of residency and/or Building Owner Certification and Work
Authorization form are difficult to obtain, LAA must document all possible
efforts toward establishing Energy Assistance household residents.
Example 3: The home ownership is part of a trust: The LAA must obtain proof of
validity of the trust, and proof of physical occupancy of the residence (signed, dated
statements, mail, ID card(s), statement from a school regarding enrollment
status/residency).
1. A representative of the trust should complete a Building Owner Certification and
Work Authorization form.
2. If proof of residency and/or Building Owner Certification and Work
Authorization form are difficult to obtain, LAA must document all possible
efforts toward establishing Energy Assistance household residents.
Notes: (1) A quitclaim deed is acceptable as proof of ownership as long as it is
notarized and filed with the county. (2) A Contract for Deed purchase is
acceptable as proof of ownership as long as it is notarized and filed with the
county.
Assessment/Final Inspection Fee:
The LAA may charge an assessment fee to the Energy Assistance Furnace Assistance component
to cover the costs of its weatherization staff’s Furnace Assessment and Final Inspection related to
administration of the Furnace Assistance Component. This fee will only be the actual costs of
salary, fringe benefits, travel expenses, and other related costs of the assessment and final
inspection. The assessment fee must not be based on comparable services by area contractors, or
designed so the agency can make a profit on the assessment and inspection, after expenses. The
Energy Assistance and IHWAP Coordinators must work with the LAA’s Fiscal Officer to
determine the hourly burdened wage. A folder containing these calculations for all applicable
LAA staff must be kept current, and must be easily accessible for OEA review.
II.10
The Assessor/Final Inspector Cost Allocation Worksheet must be used to specify what the LAA
is charging:
The hourly burdened wage for time attributed to the Assessment or Final
inspection,
The mileage to/from the furnace location at the Internal Revenue Service (IRS)
Business Standard rate (currently .57 cents per mile When calculating mileage
round to the nearest whole number: .4 or less round down, .5 or greater round up.)
Mileage is between LAA headquarters and the furnace job, or between
one home and another if more than one furnace is evaluated during a
work day.
A separate worksheet must be used for each Furnace Assistance
job/application to calculate the allowable assessment fee and the final
inspection fee.
Necessary lodging, if applicable, and/or
Other costs directly associated with Furnace Assistance Assessment/Final
Inspection.
An Assessment and a Final Inspection must be completed on all Furnace Assistance households
receiving Furnace Assistance Component benefits. The LAA Assessor should attempt to
review the heating system jointly with the contractor. In the event the LAA Assessor cannot
meet with the contractor onsite, the LAA must provide justification in the client file. Trained
individuals with the equivalent level of IHWAP certified staff will conduct the Final Inspection.
There should always be a separation of duties, to ensure proper checks and balances. LAAs with
staffing issues must follow IHWAP procedures to request waiver of the requirement that
different staff perform the assessment and the final inspection. This includes describing the issue,
proposing the short-term solution, and including a staffing plan to achieve a permanent solution.
In order to meet the 18/48 hour requirement, a contractor may conduct the Assessment. The
reasons for using a contractor to conduct the Assessment must be documented in the client file.
This Assessment must include all IHWAP equivalent tests using flue-gas analyzers and
appropriate testing for carbon monoxide, fuel leaks, draft and spillage testing etc., Refer to
IHWAP Standards Manuals for additional testing requirements. All IHWAP documentation
(Contractor Checklist, Sizing Charts, etc.) must be included in the Energy Assistance client file.
All Furnace Assistance invoices must be date-stamped by the LAA on the day they are received.
After receipt of the invoice, a Final Inspection to ensure that all work was completed in a safe
and effective manner will be conducted within 15 working days from the date of receiving the
completed Work Order and Invoice from the contractor. All costs (labor, materials, assessment,
and inspection fees) will be charged to line 0201 in the Energy Assistance budget. Budget flex
may be utilized for this line in accordance with LIHEAP HHS Grant Agreement. Payment of
invoices for Furnace Assistance should not be disbursed until after the Final Inspection has been
signed indicating the work is complete and the job is closed.
II.11
Replacement Heating Systems:
If a replacement furnace is required, a 90% plus “two pipe” (sealed combustion) system must be
installed. These systems are the same specification as the current IHWAP guidelines. An 80%
plus system can be installed only when 1) there is sufficient reason as to why a 90% plus system
could not be installed, 2) the LAA has provided sufficient documentation as to why a 90% plus
system cannot be installed and 3) OEA Weatherization has approved its installation.
If an 80% plus system is installed in a location that uses a masonry chimney, a metal flue liner
must also be installed. A flue liner will also need to be installed for the water heater if a 90%
system is installed, and the water heater remains as a stand-alone (orphaned) unit. The heating
contractor must complete a heating system sizing calculation to ensure that a properly sized
heating system is installed. Copies of these calculations are to be contained in the Energy
Assistance file.
Health and Safety:
The Furnace Assistance Component benefit is funded at the minimum amount necessary to
restore heat and to ensure all combustion appliances operate safely in accordance with IHWAP
Health and Safety procedures.
An IHWAP Health and Safety review shall be done in conjunction with the assessment. All
Health and Safety problems that would normally be corrected with IHWAP funds to safely
restore heat, including gas leaks and improper venting of any combustion appliances, must be
corrected with Furnace Assistance funds. This would include gas leaks or venting adjustments
or correction to the water heater if needed. IHWAP approved smoke detectors and carbon
monoxide detectors will be installed as a part of the Furnace Assistance Component. All
allowable Energy Assistance Health and Safety work must be installed in compliance with the
current IHWAP Standards. However, IHWAP Health and Safety items such as moisture
reduction measures, ASHRAE 62.2 ventilation and the replacement of a water heater will not be
done with Energy Assistance Furnace Assistance funding. Fire extinguishers are not a LIHEAP
allowable Health and Safety expenditure
Mechanical Measures and Costs Limits:
The maximum costs limits have increased. The new guidelines and limits are as follows:
General Heating System $3,000 +90% EFE required
General Heating System w/AC (combo system) $5,500
Boiler/Conversion/Steamer $3,500
Boiler/Conversion/Steamer w/AC $6,000
Heat Pump $4,500 8.0 HSPF/14 SEER*
Mini-Split System $2,500 8.2 HSPF / 14.5 SEER*
* must be Energy Star Rated
When replacing a natural gas or propane furnace, a 90% efficient must be used whenever
possible. In residential building or mobile home installations where a 90% efficient unit is not
possible, a waiver must be requested and OEA must approve of an 80% efficient furnace.
II.12
In certain instances such as a home with no existing ductwork, special venting problems, or an
existing boiler system with complete radiator and pipe replacement, a case-specific cost waiver
may be applied for through your Weatherization Specialist with a Waiver form (Furnace
Assistance, Waiver Request form). The waiver request needs to include a description of why the
Furnace Assistance cost limits are not adequate, a detailed listing of the work that needs to be
done, a computerized heating system sizing calculation of the Manual J Type, and digital
photographs of the existing heating system, or problem.
Mechanical costs include all associated material and labor costs of cleaning, tuning, repairing,
retrofitting, or replacing a heating system. This would include but not be limited to labor and
material for: heating systems; distribution systems; parts; transitional plenums; ductwork; shut-
off valves; sediment traps; black pipe; black pipe connectors; HVAC electrical work; chimneys;
flues; flue liners; etc. Retrofits and repairs to a heating appliance shall not exceed 50% of the
cost to replace it. If the costs of the replacement heating system exceed the IHWAP Mechanical
cost limits, then a waiver from OEA is required (Waiver Request form).
Emergency HVAC work may be more expensive, especially, during weekends, holidays, or after
hours. If a measure exceeds the IHWAP costs, the agency will document the reason for the
charge, and attach it to the contractor’s invoice. The contractor’s invoice must clearly itemize
the labor and material costs by item.
The cost of the Health and Safety items (for example, smoke detectors, carbon monoxide
detectors, and water heater repairs such as correction/repair of gas leaks, damaged fuel lines, and
ventilation problems) needed for the safe restoration of heat are not included in the cost limit.
The cost of the Furnace Assessment and Final Inspection are not included in the cost limit.
There is a maximum cost limit of $600 for Health and Safety work. Health and Safety costs that
exceed the Energy Assistance maximum limit of $600 may be submitted for a review and
approval process on a case-by-case basis. ASHRAE 62.2 Ventilation Fans are
not an allowable
expenditure with Furnace Assistance Component funds.
Dual Heating Systems:
In rare circumstances individual LIHEAP (and PIPP, when applicable) homes may have multiple
heating systems. In an effort to restore heat to the home, if both heating systems can be made
operable with minor repairs, LIHEAP funds should be allocated for those repairs. If one heating
system can be made operable with minor repairs and one heating system requires replacement
due to 50% rule or the second system is in such a state of disrepair it requires replacement,
LIHEAP funds should be allocated for the repair and replacement. In instances where both
heating systems require replacement due to 50% rule or are in such state of disrepair only one
heating can be replaced utilizing LIHEAP funds, the heating system chosen for replacement
should be the one which is most advantageous to the client. Great care should be taken when
choosing the proper system to replace. Dependent on the dual heating zones, the appropriate
zone to be chosen would be the one that provides heat to an area that protects the client and other
utilities that may be compromised due to freezing temperatures, i.e., water.
II.13
When a multiple heating system is discovered and only one system can be made operational with
LIHEAP/PIPP funds, a priority referral and assignment should be made for IHWAP services.
Based on SIR driven requirements and structural need, IHWAP may be able to complete the
furnace needs and tighten the building shell to reduce the energy burden to the client.
All questions should be directed to your assigned LIHEAP Grant Manager or IHWAP Field
Specialist. All LIHEAP/PIPP/IHWAP heating system rules apply with exception to the IHWAP
SIR requirements for LIHEAP/PIPP furnace component.
All heating system work must be guaranteed for a period of one year. A Final Inspection of the
work performed is required and the Final Inspector must give a copy of the Final Inspection form
to the client, which is signed and dated. The original which contains post flue gas analyzer tape
attached, is kept in the client file. The completed Final Inspection form sets the date for the
guarantee and assurance period of one year from the date of Final Inspection or (one year from
the work complete date listed on the Assurance and Guarantee of Work form, if the Final
Inspector did not require any call-back work which must be documented with Weatherization
Callback/Rework Notice). The Final Inspector will insert the appropriate one-year date range,
signature, and Final Inspection date on the Assurance and Guarantee of Work form which was
received from the contractor; the original Guarantee goes to the homeowner and a copy is
retained for the LAA Furnace Assistance file.
NOTE: If the client remains inaccessible after repeated and well documented attempts to
conduct the Final Inspection, the “Final Inspection Attempt Letter” should be mailed to the
client. Sometimes this needs to be done to set a Final Inspection Date and close the job.
After Final Inspection, but within the same Program year, sometimes a client will report an
unforeseen problem with the Furnace Assistance job. Issues regarding the furnace that may not
necessarily be a contractor call-back or be covered under the contractor’s Assurance and
Guarantee of Work might involve some additional costs to a closed (LAA Paid) Furnace
Assistance job. This type of cost is rare, but is has happened that something was not assessed
properly or the repairs were not enough to keep an old furnace in safe operating condition (as
two examples). In this type of situation the Grant manager and IHWAP Specialist must be
notified and give consent prior to sending the LAA staff person back to the home (keep
documentation of consent in the client file). If needed, the Furnace portion of the application on
LIHEAP.net can be placed back into Pending Status for further data entry (up to the allowable
amounts and following the repair vs. replace guidelines, etc.).
The LAA must use approved IHWAP contractors and procure prices for this component without
reestablishing new bidding procedures or Energy Assistance may procure their own contractors
and prices separate from the Weatherization Program. In the event that IHWAP contractors
cannot be used due to the timelines for necessity of restoring heat to the client’s home, the LAA
can pay current market rate and select local licensed contractors to perform the work as long as
emergency procurement procedures are met.
Furnace Assistance Restrictions - No Furnace Assistance applications will be taken after
March 31
st
. No furnace work will be performed on any furnace in a household that has been
condemned or otherwise deemed uninhabitable by the State or any unit of local government or
by any department or subdivision of the State or local government. In addition, no work will be
II.14
done on any furnace in any household that is pending foreclosure or for sale within 90 days of
application date. The Furnace Assistance Component is limited to homeowners only. Central
heating systems in multi-family buildings are not eligible for the Furnace Assistance Component.
These situations can be referred to IHWAP.
Only one furnace replacement benefit per dwelling is allowed for a period of 10 years. An
example of this would be if a client received a new replacement furnace on November 12, 2005,
they would not be able to get an additional replacement furnace at the same address until after
November 12, 2015. The dwelling of an eligible household may receive furnace repairs once
each program year.
Agencies will need to keep a file listing the address of households receiving a furnace. It does
not matter if the home has previously received IHWAP assistance. In cases where the home has
not been previously weatherized, the Energy Assistance household should be immediately
referred to IHWAP for weatherization services. They will receive a special Energy Assistance
priority that will allow them to be weatherized ahead of other existing IHWAP clients if the
client has not received prior IHWAP services.
Deferral/Walk-Away Policy: The decision to defer Furnace Assistance or, in extreme cases,
provide no Furnace Assistance services, is difficult but necessary in some cases. The Deferral or
Walk-Away policy for a Furnace Assistance application will also follow IHWAP policy, as long
as it is Not SIR Related. As part of this Deferral or Denial process, the “Denial of Furnace Work
Letter,” and/or “Notice of Hazardous Condition Form” must be submitted to the client and a
copy must be included in the client file.
The Furnace Assistance section of the client file must contain the original document or a copy of
the following forms and documents:
The Client Information and Furnace Assessment Worksheet (original)
The home ownership documentation which may include, but is not limited to: a copy of
the deed; the property tax bill; mobile home title; a mortgage payment book coupon; an
authorization statement from the executor of a blind trust; a contract for deed; a quitclaim
deed, or other legal documentation on home ownership that has been filed with the
County Clerk.
A Building Owner Certification and Work Authorization, signed by all owners (original)
For furnace replacements, a Furnace Replacement Justification Form must be in each file.
This form is documentation and affirmation that comparison of the costs of needed repairs
exceed by 50% the cost of a new furnace costs that the 50% rule is met. It is signed with
both the LAA Authorization and the Contractor/Crew member as affirmation (original).
For furnace jobs that had an addition or deletion of work after initial assessment, there
must be a Change Order Request Form approved (signed) by the LAA and agreed to
(signed) by the contractor/crew member (original).
A Manual J (or equivalent) sizing chart for all furnace replacements (original)
II.15
If an 80% plus furnace was installed, the file must contain sufficient written explanation
as documentation of why a 90% plus system could not be installed, together with a copy
of approved Furnace Wavier Form (original).
The contractor’s itemized invoice (original)
The Mechanical Contractor Checklist (original)
The Contractor Release of Lien (original)
The Contractor Assurance & Guarantee of Work (copy with original to client)
A completed IHWAP Inspection Detail Form (original, with copy to client)
The final status Furnace page from LIHEAP.net, with “Activity history” details of job
assignments, Assessment/Final Inspection dates/staff, the check number for LAA Paid,
etc. (screen print)
Energy Assistance Furnace Assistance Waiver Request form, if applicable (original)
Notice of Hazardous Condition Form, if applicable (copy, original to client)
Assessor/Final Inspector Cost Allocation Worksheet (original)
Denial of Furnace Work Letter, if applicable (copy)
Final Inspection Attempt Letter, if applicable (copy)
C. Cooling Assistance
LAAs will not operate a Summer Energy Assistance Program in the 2016 program year.
SECTION II
ENERGY ASSISTANCE PROGRAM BENEFITS
EXHIBITS
Map of Local Administering Agencies (LAAs) ........................................II.16
Map of Six Regions ...................................................................................II.17
Map of North/South Benefit Areas ..........................................................II.18
Energy Assistance Program Matrix North ................................................II.19
Energy Assistance Program Matrix South ...............................................II.20
Client Information and Furnace Assessment Worksheet ..........................II.21
Furnace Replacement Justification Form ..................................................II.22
Final Inspection Summary Report .............................................................II.23
Contractor Assurance and Guarantee of Work ..........................................II.24
Contractor Checklist ..................................................................................II.25-26
Contractor Release of Lien ........................................................................II.27
Building Owner Certification and Work Authorization ............................II.28
Energy Assistance Program Furnace Assistance Waiver Request ............II.29
Change Order Request Form .....................................................................II.30
Assessor/Final Inspector Cost Allocation Worksheet ...............................II.31
Denial of Furnace Work ............................................................................II.32
Notice of Hazardous Condition Form .......................................................II.33
Final Inspection Attempt Letter Sample ...................................................II.34
Callback/Rework Notice ...........................................................................II.35
II.16
II.17
II.18
0 % TO 50 % FUEL TYPE 123456 OR MORE
FAMILY 30 DAY 30 DAYS NAT. GAS/OTHER PRIMARY $448 $448 $466 $501 $512 $530
SIZE INCOME INCOME SECONDARY $211 $211 $241 $270 $293 $315
1 $0 $490 TOTAL $659 $659 $707 $771 $805 $845
2 $0 $664
3 $0 $837 ALL ELEC. TOTAL $553 $553 $607 $666 $709 $758
4 $0 $1,010
5 $0 $1,184 PROPANE PRIMARY $546 $546 $568 $612 $625 $646
6 $0 $1,357 SECONDARY $315 $315 $378 $436 $470 $518
7 $0 $1,530 TOTAL $861 $861 $946 $1,048 $1,095 $1,164
8 $0 $1,704
9 $0 $1,877 FUEL OIL PRIMARY $546 $546 $568 $612 $625 $646
10 $0 $2,050 SECONDARY $315 $315 $378 $436 $470 $518
TOTAL $861 $861 $946 $1,048 $1,095 $1,164
CASH $130 $130 $140 $150 $160 $170
51% TO 100 % FUEL TYPE 123456 OR MORE
FAMILY 30 DAY 30 DAYS NAT. GAS/OTHER PRIMARY $358 $358 $372 $401 $410 $424
SIZE INCOME INCOME SECONDARY $169 $169 $193 $216 $235 $252
1
$491 $981
TOTAL $527 $527 $565 $617 $645 $676
2
$665 $1,328
3
$838 $1,674
ALL ELEC. TOTAL $442 $442 $487 $533 $568 $605
4
$1,011 $2,021
5
$1,185 $2,368
PROPANE PRIMARY $437 $437 $453 $489 $500 $517
6
$1,358 $2,714
SECONDARY $252 $252 $302 $348 $376 $414
7
$1,531 $3,061
TOTAL $689 $689 $755 $837 $876 $931
8
$1,705 $3,408
9
$1,878 $3,754
FUEL OIL PRIMARY $437 $437 $453 $489 $500 $517
10
$2,051 $4,101
SECONDARY $252 $252 $302 $348 $376 $414
TOTAL $689 $689 $755 $837 $876 $931
CASH $104 $104 $112 $120 $128 $136
101 % TO 150 % FUEL TYPE 123456 OR MORE
FAMILY 30 DAY 30 DAYS NAT. GAS/OTHER PRIMARY $269 $269 $279 $301 $308 $318
SIZE INCOME INCOME SECONDARY $127 $127 $145 $162 $175 $188
1
$982
$1,471 TOTAL $396 $396 $424 $463 $483 $506
2
$1,329
$1,991
3
$1,675
$2,511 ALL ELEC. TOTAL $331 $331 $364 $400 $425 $454
4
$2,022
$3,031
5
$2,369
$3,551 PROPANE PRIMARY $327 $327 $341 $366 $375 $388
6
$2,715
$4,071 SECONDARY $188 $188 $227 $261 $282 $312
7
$3,062
$4,591 TOTAL $515 $515 $568 $627 $657 $700
8
$3,409
$5,111
9
$3,755
$5,631 FUEL OIL PRIMARY $327 $327 $341 $366 $375 $388
10
$4,102
$6,151 SECONDARY $188 $188 $227 $261 $282 $312
TOTAL $515 $515 $568 $627 $657 $700
CASH $100 $100 $100 $100 $100 $102
2016 LIHEAP MATRIX - North
II.19
0 % TO 50 % FUEL TYPE 123456 OR MORE
FAMILY 30 DAY 30 DAYS
N
AT. GAS/OTHER PRIMARY $391 $391 $407 $439 $451 $466
SIZE INCOME INCOME SECONDARY $178 $178 $204 $230 $249 $268
1 $0 $490 TOTAL $569 $569 $611 $669 $700 $734
2 $0 $664
3 $0 $837 ALL ELEC. TOTAL $459 $459 $508 $561 $597 $639
4 $0 $1,010
5 $0 $1,184 PROPANE PRIMARY $477 $477 $497 $536 $549 $568
6 $0 $1,357 SECONDARY $270 $270 $327 $376 $407 $449
7 $0 $1,530 TOTAL $747 $747 $824 $912 $956 $1,017
8 $0 $1,704
9 $0 $1,877 FUEL OIL PRIMARY $477 $477 $497 $536 $549 $568
10 $0 $2,050 SECONDARY $270 $270 $327 $376 $407 $449
TOTAL $747 $747 $824 $912 $956 $1,017
CASH $110 $110 $115 $125 $135 $140
51% TO 100 % FUEL TYPE 123456 OR MORE
FAMILY 30 DAY 30 DAYS
N
AT. GAS/OTHER PRIMARY $312 $312 $326 $352 $360 $372
SIZE INCOME INCOME SECONDARY $143 $143 $164 $183 $199 $214
1
$491 $981
TOTAL $455 $455 $490 $535 $559 $586
2
$665 $1,328
3
$838 $1,674
ALL ELEC. TOTAL $367 $367 $407 $449 $476 $510
4
$1,011 $2,021
5
$1,185 $2,368
PROPANE PRIMARY $381 $381 $398 $429 $439 $455
6
$1,358 $2,714
SECONDARY $216 $216 $261 $301 $326 $359
7
$1,531 $3,061
TOTAL $597 $597 $659 $730 $765 $814
8
$1,705 $3,408
9
$1,878 $3,754
FUEL OIL PRIMARY $381 $381 $398 $429 $439 $455
10
$2,051 $4,101
SECONDARY $216 $216 $261 $301 $326 $359
TOTAL $597 $597 $659 $730 $765 $814
CASH $100 $100 $100 $100 $108 $112
101 % TO 150 % FUEL TYPE 123456 OR MORE
FAMILY 30 DAY 30 DAYS
N
AT. GAS/OTHER PRIMARY $235 $235 $246 $264 $270 $280
SIZE INCOME INCOME SECONDARY $106 $106 $122 $137 $149 $161
1
$982
$1,471 TOTAL $341 $341 $368 $401 $419 $441
2
$1,329
$1,991
3
$1,675
$2,511 ALL ELEC. TOTAL $275 $275 $304 $336 $357 $383
4
$2,022
$3,031
5
$2,369
$3,551 PROPANE PRIMARY $286 $286 $298 $322 $330 $341
6
$2,715
$4,071 SECONDARY $162 $162 $196 $225 $244 $269
7
$3,062
$4,591 TOTAL $448 $448 $494 $547 $574 $610
8
$3,409
$5,111
9
$3,755
$5,631 FUEL OIL PRIMARY $286 $286 $298 $322 $330 $341
10
$4,102
$6,151 SECONDARY $162 $162 $196 $225 $244 $269
TOTAL $448 $448 $494 $547 $574 $610
CASH $100 $100 $100 $100 $100 $100
2016 LIHEAP MATRIX - South
II.20
II.21
ENERGY ASSISTANCE PROGRAM FURNACE ASSISTANCE
CLIENT INFORMATION AND FURNACE ASSESSMENT WORKSHEET
CLIENT INFORMATION – COMPLETED BY LAA STAFF TAKING FURNACE APPLICATION
Energy Assistance Program Application #______________________
Client’s Name SSN
Address Date Time
Phone (____) ______ -________ Temperature at time of application: _______(qF)
Furnace Problems _________________________________________________________
________________________________________________________________________
Date All Documentation Received
Date Heat Restored
Is client the homeowner? Yes No
Ownership documentation
(attach to worksheet) ______________________________________________________
ASSESSMENT OF FURNACE CONDITION COMPLETED BY ASSESSOR
NOTE: If a contractor is utilized to conduct the Assessment, the reasons must be documented in the client file.
Assessor Name Date
What is wrong with furnace?
Is the furnace operational? Yes No Comments:
Is the furnace red-tagged? Yes No Comments:
NOTE: If Furnace cannot be repaired, and it must be replaced, the “Furnace Replacement Justification Form” must be
thoroughly completed by the Assessor (or Contractor/Crew), including the cost comparison showing justification for
replacement. When additional parts or labor need to be added to the furnace job after the initial furnace Assessment, the
Change Order Request Form must be used in the same manner as with Weatherization jobs.
ASSESSOR’S DETAILED COMMENTS:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
______________________________________________________________________
FURNACE COST
Repair $__________ (attach contractor’s Itemized Invoice)
Replacement $ ________ (attach Furnace Replacement Justification Form, including justification for
replacement, and contractor’s Itemized Invoice)
Furnace Contractor: ________________________________________________________
Agency Staff Signature:___________________________________________Date: ______________
II.22
FinalInspectionSummaryReport
YesපNoප
PreWxCFMͲ50Reading:
CAZ1:
CAZ2:
CAZ3:
CFMͲ50TargetNumber
(ASHRAE62.2):
IntermediateReading:
FinalCFMͲ50Reading:
AtticZoneReading:
CrawlZoneReading:
OtherZoneReading:
RatedInput
AllrequiredTestingDone?:
Measured
If"No"explainwhy:
Draft/IWC
C/Oppm
FlueC/O2
Efficiency
Date AdditionalSignature
Date
IamsatisfiedwiththeWeatherizationorEAFurnaceworkcompletedonthisdwelling?
Smoke
DetecͲ
tors:
FinalInspectorSignature
YesපNoප
Arealllaborhours,materialsused,andactualcostsaccountedfor?
ILLINOISHOMEWEATHERIZATIONASSISTANCEPROGRAM
&ENERGYASSISTANCEFURNANCECOMPONENT
Lite
Blubs:
CO
DetecͲ
tors:
Fire
ExtinͲ
guishers:
IhavebeenprovidedtheAssuranceandGuaranteeofWork by:
Ihavebeeninstructedinuseandmaintenanceofallitemsandmeasuresinstalledincluding
SmokeDetectors,C/ODetectors,andExhaustFans(ifapplicable)andprovidedwithequipment
manuals?
whichguaranteesthecompletedWeatherization/EnergyAssistanceFurnaceWorkforoneyearfromthe
FinalInspectionDate .Problemsthatoccuraftertheguaranteeexpiresorthatareunrelatedthe
Weatherization/EAFurnaceworkareacknowledgedastheresponsibilityoftheClient/Homeowner.
ToBeCompletedWiththeClient/Homeowner
YesපNoප
CheckhereifclientRefusedRemovalofStandͲAloneElectricSpaceHeater(s).Checkingthisboxservesasawaiverthat
theclientisacceptingpotentialhazardsresultingfromcontinueduseoftheelectricspaceheater.
Client'sSignature:_______________________________________________
_
Yesප Noප
WaseachbuildingsectionproperlyassessedandaddressedontheInputDocument?(N/AEAFurnace)
WaterHeater: HeatingSystem:
IsalloftherequireddocumentationintheClientFileandhasitbeenreviewed?
WasallweatherizationorEAfurnaceworkcompletedinaccordancewiththequalitycontrolstandardsand
specificationsassetforthintheIHWAPManuals?
Yesප Noප
YesපNoප
YesපNoප
WaterHeaterSystem:
Seconds
toDra
f
t:
Seconds
toDraft:
HeatingSystem:
PostͲWeatherizationDiagnosticReadings(@FinalInspection)
Date:_________________________________
SpillageTestͲOut
Worse CaseDepressurization
FlueGasTestin
g
Number
Installed:
Comments:
Blower DoorReadings
N/AtoEAFurnace
ZoneReadings
Client Name:
J
obAddress:
IHWAP Jobnumber
orEAAppNumber:
Contractor(s)Name(s)
Other:(describe)
II.23
II.24
ENERGY ASSISTANCE - FURNACE ASSISTANCE
CONTRACTOR ASSURANCE AND GUARANTEE OF WORK
(to be given to the client at Final Inspection & a copy in the client file)
I, of the following firm,
Name
Guarantee the workmanship for installation of:
at ___________________________________________________________________________for
one year, beginning _____________________ and ending ________________________ in
accordance with manufacturer’s instruction and the American National Standards Institute (ANSI)
procedure.
Contractor’s Signature _______________________________
Work Complete Date _______________________________
Final Inspector’s Signature __________________________
Final Inspection Date ______________________________
NOTE: If the workmanship passed the Final Inspection, then the Work Complete Date starts the one
year guarantee. However, if there is a call back issue, the one year guarantee starts with the Final
Inspection date. The one-year period must be filled in by the Final Inspector. The original should be
given to the client/owner (mailed or hand-delivered, after a copy is made for the client’s furnace file).
II.25
II.26
II.27
ENERGY ASSISTANCE PROGRAM
FURNACE ASSISTANCE
CONTRACTOR RELEASE OF LIEN
WHEREAS, we the undersigned have installed materials and furnished labor and/or equipment for the
Furnace Retrofit project for:
________________________________________________________________
(Client’s Name & Address)
WHEREAS, all materials were installed and labor was furnished according to a written agreement
dated ____________________ between ______________________________
_______________________________________ (herein referred to as the LAA) and
_________________________________ (hereafter referred to as the contractor); WHEREAS, we the
undersigned have agreed to release any and all claims and liens which we have, or might have, against
the owner of said property, the occupier of said property, and the LAA by reason of the labor,
materials, and equipment furnished by us in connection with said Weatherization Project.
NOW THOSE PRESENT WITNESSETH that we, the undersigned, in consideration for the sum listed
on the contract and any attached change Work Orders, the receipt whereof we do hereby acknowledge,
do hereby release, remiss, and forever quit any or all manner of liens, claims, and demands whatsoever
which we now have, or might have in the future against the owner and occupier of said property and
the LAA.
_______________________________ _______________________________
(Company Name) (By)
Date Job Started: ____________________
Date Job Completed: ____________________
Failure to complete this form correctly could result in delay of payment.
II.28
ENERGY ASSISTANCE PROGRAM
FURNACE ASSISTANCE
BUILDING OWNER CERTIFICATION and WORK AUTHORIZATION
I, ____ , certify that I am the owner/authorized agent
(print name)
indicated (Documentation) for the property at
I further certify that I have given my permission to the weatherization agency or its
designated agent to allow work on the dwelling and/or primary heating system at the property listed
above in accordance with the following provisions (and such other particulars as may be attached to
this agreement).
I understand that all work that may be done to the primary heating system will be guaranteed for a
period not to exceed one year. After that time, I agree to be responsible for any related costs to the
primary heating system.
____________________ ______________________________
Signature Date
Homeowner Phone # ____________________
Landlord/Authorized Agent Phone # ____________________
Illinois Home Weatherization Assistance Program / Low Income Home Energy Assistance Program
Office of Energy Assistance State of Illinois Department Of Commerce and Economic Development
Check one:
___ Weatherization Mechanical Cost Waiver Request ___ Furnace Assistance Mechanical Cost Waiver Request
Costs exceeding mechanical cost limits without prior authorization from OEA will be disallowed.
Complete this request form in its entirety. An agency making an incomplete submission will be required to resubmit which will delay processing.
Agency:
Assessor: Date
Assessed:
IHWAP Job #:
Application #:
Funding
Source:
Contractor:
Contractor's
Address:
Client Name:
Client's Address:
Detailed Reason For Replacement
Please be clear, concise and thorough on the reason for replacement. This expedites the approval process. A detailed
cost breakdown of material and labor descriptions is required. Use your procured IHWAP approved catalog mechanical
prices. Include heating system make, model, and size and detailed work to be performed -no general classifications.
Detailed color digital photos of the existing conditions, clearly showing why the request is being submitted, are
mandatory. If duct work is required take photos of the existing ducts and/or lack of ducts. If no furnace is present, state
what was previously used to heat the home. LIHEAP funds cannot be used if there is no existing furnace/heating
system. A computerized Manual J heat load calculation is also required with this submittal.
Material / Labor Description QTY Material Labor
Total
Complete and Thorough description of Why waiver is needed:
Other Weatherization Measures to be completed:
R – September 2014
II.29
II.30
ENERGY ASSISTANCE PROGRAM
FURNACE ASSISTANCE
CHANGE ORDER REQUEST FORM
(for addition or deletion of work)
CLIENT NAME: ____________________ APPLICATION ID #: __________________________
The goal of Furnace Assistance is to restore the heating system back to safe and effective operation.
This is not a “furnace replacement program.”
NOTE: If the furnace must be replaced, a Furnace Replacement Justification Form (not a Change
Order Request Form) must be completed by the individual conducting the assessment.
THIS CHANGE ORDER REQUEST IS AN AGREEMENT BETWEEN THE UNDERSIGNED
CONTRACTOR AND _____________________________
(NAME OF LAA) TO APPROVE AND CARRY OUT
WORK THAT IS SUBSTANTIALLY DIFFERENT THAN THE ORIGINAL PROJECT SCOPE. BOTH
PARTIES UNDERSTAND THAT THE REQUESTED MATERIAL/LABOR CHANGES, AS
SPECIFIED BELOW, MAY ALTER THE PROJECT'S PRICE AND SCHEDULE. IT IS ALSO
UNDERSTOOD THAT ANY DIFFERENCES IN ESTIMATED COSTS DUE TO THIS CHANGE
ORDER WILL BE ACCOUNTED FOR IN THE REGULAR PAYMENT SCHEDULE.
EXPLANATION FOR ADDITION OR DELETION OF WORK:
Changes either adding or deleting material/Labor from the home will change the estimated total costs
on the work order. The Contractor (or Crew member) will contact the Agency and receive
authorization before making changes. The Contractor will manually calculate new costs at bottom of
this form to reflect the requested changes. The Contractor will provide all labor and material for the
following work:
__________________________________________________________________________________________
__________________________________________________________________________________________
_____________________________________________________________________
Labor Costs: ______________ (Add/Deduct) Material Costs: _______________ (Add/Deduct)
Does Change Affect Schedule?
Ŀ Yes Ŀ No
New Estimated Completion Date, if applicable: _________________
Approved: __________________________________________ __________________________
Signature of Agency Staff Approving Change (Date)
Agreed: __________________________________________ __________________________
Contractor Signature or Crew Member Signature (Date)
II.31
ENERGY ASSISTANCE PROGRAM
FURNACE ASSISTANCE
Assessor/Final Inspector Cost Allocation Worksheet
Instructions: A separate worksheet must be used for each Furnace Assistance job/application to
calculate the allowable Assessment fee and the Final Inspection fee.
Complete each line or write N/A if not applicable:
Date: ___________________________
Assessment or Final Inspection (circle one)
Assessor/Final Inspector Name(s): _____________________________________________
Application Number: ___________________________
Burden Wages: ___________________________
Round trip Mileage ___________________________
Lodging: ___________________________
Other: ___________________________
Total fees: ___________________________
Comment or Description: _____________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Authorized by Agency Staff: _______________________________, _______________________
Name Title
Date
Enter this amount
on LIHEAP.net
II.32
DENIAL OF FURNACE WORK
Date
Applicant's Name
Applicant's Address
Dear
Your application for Furnace Assistance through the Energy Assistance Program has been
considered and determination was made that:
Heating system work cannot be done because repair, retrofit or replacement costs exceed the
allowable limits for our program. If you can obtain funding by _____________________
(date),
you will receive furnace assistance.
A required matching contribution for the cost of a replacement heating system was not made by
your landlord therefore no furnace work will be performed. If another source of funding can
be located for these activities by __________
(date), you will receive heating system
assistance.
Your heating system was determined unsafe and a required matching contribution for the cost of
a replacement system was not made by you or your landlord. It is the policy of the
weatherization program that no weatherization work be performed on housing units with unsafe
heating systems. If your landlord agrees to make the necessary matching contribution or
you can obtain another source of funding for these activities by ________ ,
(date)
you will receive weatherization assistance. Remember, you have a right to reapply for
assistance.
You have a right to appeal this decision by requesting an informal conference at our agency
within 30
days of this letter by contacting ________________________________________________.
Agency Representative
Sincerely,
(Agency Representative)
cc: Applicant's File
Enclosure: "Your Rights" brochure
II.33
II.34
SAMPLE FINAL INSPECTION ATTEMPT LETTER
Date:
Dear Mr./Mrs._______________:
Enclosed please find a final inspection form for the Weatherization Assistance or Energy
Assistance Furnace - Heating System work that was done to your home. We have made several
attempts to contact you to perform the final inspection on your home, but have not been able to
find you home.
Enclosed you will find a copy of the final inspection sheet; this form must be signed by you next
to the "X", and returned to our agency. If you wish, please make comments about the work that
was done. Please mail the signed form to our office in the enclosed self-addressed stamped
envelope. If the signed final inspection sheet is not returned by , we will
consider the work to be satisfactory and your file will be closed.
Thank you for your assistance and if you should have any questions, please contact the
Weatherization Office at ________________________________________________________.
Sincerely,
II.35
SECTION III
OUTREACH
SECTION III - OUTREACH
Outreach Responsibilities .................................................................................III.1
Outreach Plan ....................................................................................................III.2
Coordination and Referral Procedures ..............................................................III.2
Consumer Education .........................................................................................III.4
Publicity ............................................................................................................III.4
III.1
SECTION III
OUTREACH
Outreach is the agency’s first contact with a potential client. This contact may be as direct
as a walk-in client who has questions about energy assistance or as indirect as a person
reading an agency’s program flyer posted on the bulletin board at the local grocery store.
Agencies perform many outreach activities during the course of a normal day.
Outreach Responsibilities
Required by the grant agreement, agencies must carry out the following responsibilities
with regard to outreach:
General information brochures and/or posters that include the agency name,
address, and telephone number will be disseminated throughout the service
area.
Local offices of other energy-related agencies and low-income service
providers will be contacted to coordinate outreach/publicity efforts and to
implement referral mechanisms.
Other groups, clubs, churches, schools and local units of government will be
contacted to coordinate outreach/publicity efforts.
The offices of State and U.S. Senators and Representatives and other
officials such as township supervisors will be contacted to coordinate
referrals and publicity efforts.
A news release about the program, which contains a program description,
eligibility criteria, and application procedures including a list of the
documentation that the applicant is expected to provide, will be developed
and utilized. Prior to sending press releases about the program, all LAAs
must submit a DRAFT to Maria.Gallardo@illinois.gov
, with a copy to your
Grant Manager. OEA staff will review the DRAFT and contact the LAA.
Other local service agencies will be contacted to arrange sites for intake that
are preferably transportation accessible to disabled persons and visible at the
community level (i.e., senior centers, nutrition sites, etc.).
Local resources such as DHS and community colleges will be contacted to
arrange for interpreters as needed.
Where appropriate, door-to-door canvassing will be conducted to identify
potential applicants.
Top priority will be placed on outreach efforts to seniors, disabled and low-
income minority heads of households, but without discrimination against any
other population groups.
To summarize, the agency must develop outreach procedures that ensure the eligible
population is aware of and has access to Energy Assistance Program benefits. It is
important that each agency develop a positive working relationship with groups in the
community that have regular contact with low-income populations.
III.2
Outreach Plan
Because proper outreach is so critical, agencies should devote time and effort to developing
an Outreach Plan. The plan should include the number and time commitments of outreach
staff employed by the agency, as well as, volunteers and other staff not employed by the
agency. An intake schedule should be devised that lists the sites, dates and times each site
will be taking applications. Also, a list of resources that can be contacted to arrange for
interpreters should be included. Training procedures for all outreach workers must be
devised and delineated in the Outreach Plan. Training guidelines should include times, size
of groups, handout materials, etc.
Coordination and Referral Procedures
The Illinois Energy Assistance Program is only one of several residential energy assistance
programs. Often a client who is not eligible for Energy Assistance may be eligible for a
utility-sponsored program such as “Add a Dollar, Share the Warmth,Rate Reliefor
Dollar More”. The agency needs to be aware of these other energy assistance programs
and include such information in outreach materials.
In addition to making referrals to energy assistance programs, the agency should determine
other needs of the household and make the appropriate referrals to other low-income
service providers. For example, does the household know about and utilize
benefits/programs such as Circuit Breaker tax relief, SNAP (Supplemental Nutrition
Assistance Program), CSBG, IHWAP, Supplemental Security Income (SSI), senior
services such as Homemaker and Chore Service, nutrition programs, Head Start or other
local discount programs?
Adequate information should be available for agency staff to coordinate services and refer
clients responsibly at the local level. It is strongly advised that a directory of services be
compiled and routinely updated. The Service Directory should be developed for
distribution to both the outreach worker and the client. At a minimum it should include the
information below:
program title
program components
eligibility criteria
limitations on availability
contact agency/person and phone number
III.3
A possible entry in the Service Directory could resemble the following:
PROGRAM NAME: Jaycees Neighborhood Repair Program
Contact Person: John Brown
Agency: Jaycees
Address: 2714 W. Elm, Center City, Illinois 60000
Telephone: 312/555-5678
Effective date: Ongoing
Eligibility criteria: Age 60 or over, must reside within Maple Grove
subdivision
Program description: At request of individual, Jaycees (volunteers) make
repairs/improvements on homes (interior and/or exterior);
up to $400 in materials may be used.
Finally, as a low-income service provider, the agency will regularly receive inquiries and
referrals from various agencies, hotlines and clients. The service directory will assist in the
proper routing of these calls. The following toll-free hotlines can be of assistance to you
and your clients.
HOTLINE
AGENCY
PURPOSE
800/252-8966
Illinois Department on
Aging
Senior Help Line
800/843-6154
DHS
Help Line-Cash, Medical &
SNAP
800/447-4278
HFS
Child Support Services
800/252-2873
DCFS
Child Abuse Hotline
800/524-0795
ICC - Consumer Service
Division
Concerns about ICC
regulated utilities
312/663-1522
Illinois Migrant Council
Assistance to migrant and
seasonal farmworkers
(MSFW) & their families
217/522-7016 (V/TTY)
CCDI – Coalition of
Citizens with Disabilities
Advocacy for disabled
individuals
800/669-5556
CUB Citizens Utility
Board
Assistance in regards to utility
companies
877/411-WARM
(9276)
Keep Warm Illinois
Households needing
home energy
assistance and
weatherization
Energy cost savings
tips and tips to stay
warm, healthy and
safe during winter
III.4
Consumer Education
Consumer education should be predicated upon raising the Energy Assistance Program
applicant’s awareness about energy conservation by providing energy-saving tips and
related brochures; providing information about community-based resources; securing
affordable energy-saving appliances; referring Energy Assistance Program applicants to
community-based workshops and energy-related educational program sites; and
organizing energy conservation workshops.
It is recommended that agencies provide a consumer education packet for each Energy
Assistance Program applicant. Consideration should be given to developing materials
which explain/demonstrate energy conservation techniques. Furthermore, information to
help strengthen the Energy Assistance Program applicant’s financial literacy should also be
provided. This includes, but is not limited to, information on spending habits, priorities,
budgeting, and saving. This education effort could make the difference between the client
being able to pay the bill or being disconnected.
It is strongly advised that information about agencies such as the Citizens Utility Board
(CUB) which works for lower rates and better service from the state’s investor-owned
electric, gas and telephone companies be shared with the Energy Assistance Program
applicant. CUB’s website offers a wealth of information on the services they provide
and can be accessed by logging on to: http://www.citizensutilityboard.org.
In addition to CUB, information and frequently asked questions about Alternative Retail
Energy Suppliers (ARES) and Alternative Retail Gas Suppliers (ARGS) can be accessed
by logging on to: http://www.pluginillinois.org/faq.aspx
and
http://www.icc.illinois.gov/ags/faq.aspx.
Publicity
Good program publicity is critical. Whether your agency expends its funds in a month or
still has money left at the end of the year, a good publicity effort lets all potential clients
know when and where to apply for Energy Assistance. Furthermore, publicity aimed at the
general public lets the communities you serve know the good things you are doingbad
news travels fast; good news takes an effort!
Agencies are encouraged to participate in activities that will educate the public and
publicize the program such as writing newspaper articles, giving presentations before
local organizations, doing presentations for children during classroom sessions or
assemblies, and participating in local cable television public service programs and
announcements.
SECTION IV
INTAKE
SECTION IV - INTAKE
Intake Strategy ..................................................................................................IV.1
Home Visits/Mail-In Applications ....................................................................IV.2
Special Accommodations..................................................................................IV.3
Locations for Outreach/Intake ..........................................................................IV.3
Scheduling Outreach/Intake ..............................................................................IV.4
Application/Eligibility ......................................................................................IV.4
Authorization to Apply .....................................................................................IV.4
Client Confidentiality Rights ............................................................................IV.5
Client Appeals Rights .......................................................................................IV.5
Section IV Exhibits ........................................................................................IV.6
IV.1
SECTION IV
INTAKE
Each agency must establish an intake system that can collect the data needed to certify
that each applicant (i.e., each individual in the Energy Assistance Program household) is
eligible for energy assistance. The importance of the intake process cannot be
overemphasized. Agencies should examine different methods of taking Energy
Assistance Program applications so that a logical, systematic approach to serving clients
is developed. A well-handled intake system improves the efficiency of the program and
results in good public relations.
No applications are to be solicited, completed, or appointments scheduled prior to
the program start date.
Intake Strategy
The agency may develop its own procedures, but must meet the first come, first serve
criteria. In order to serve the client quickly and efficiently, and, paper applications must
be minimized accordingly. For the 2016 Energy Assistance Program, it will be even
more important to take on-line applications.
One or more of the following intake methods should be used:
Taking applications at several sites
Different sites may be located throughout the county where applications are taken
three or four days a week. The site(s) may then be closed for the remainder of the
week to verify applications and reconcile the amount of funds remaining. This
procedure may be repeated until all dollars are obligated/authorized.
Rotating sites around the county
Only one site would be open on any particular day. Continue rotating sites until all
funds are obligated/authorized. Under this system, the agency may elect to take
applications in its central office every day in addition to the other locations.
Using a walk-in number system
The agency may elect to hand out numbers when a site is open for intake to
applicants as they enter. Applications are then taken in order. If applicants are not
present when their number is called, they will be bypassed and may pick up a new
number when they return. The agency may determine that a set number of
applications (e.g., 20) can be taken at a particular site on a given day, handing out
just that number. Or, the agency may continue handing out numbers as potential
IV.2
applicants continue to arrive, scheduling their application on the next day the site is
open.
Take applications on an appointment basis
Applicants are assigned the first available appointment time convenient for them.
NOTE: The Department encourages LAAs to use two intake systems (appointment
and walk-ins) but it is at the discretion of the LAA to use their preferred method.
APPOINTMENTS MUST BE GIVEN WITHIN 60 CALENDAR DAYS OF THE
DATE THE APPOINTMENT IS REQUESTED. AGENCIES THAT UTILIZE
APPOINTMENT SYSTEMS MUST, AT A MINIMUM, TAKE APPOINTMENTS
AT LEAST FOUR DAYS PER WEEK AND ALLOW FOR WALK-IN CLIENTS
AT LEAST ONE DAY PER WEEK.
It is strongly recommended that the agency consider using an appointment system for at
least a percentage of their applications. It is especially useful in situations where there
are many applicants waiting to be served and in less populated areas where temporary
sites and periodic scheduling are used. In the first case, an appointment system reduces
the waiting time and provides better service for the applicants. In the second situation,
the agency knows the exact number of applicants it will serve and can predict the amount
of time and number of staff needed. The agency may also wish to use an optional
Appointment Form to assist in the application process. Agencies should also move to
automate their intake using LIHEAP.net to enter applications on site.
Home Visits/Mail-In Applications
Sites must be accessible to persons with disabilities in accordance with the Americans
with Disabilities Act (ADA); however, there are times when a home visit or the mail-in
application procedure may be necessary to serve an applicant. A home visit must be
made when:
a relative or friend cannot make application on behalf of the applicant at a regular
site,
the individual has stated the need for a special accommodation because of a
disabling condition, or
all other methods for getting the individual to the site have been exhausted.
Home visits should be arranged on an appointment basis. Remember to telephone the
applicant an hour prior to the appointment to ensure the individual is prepared to have an
application taken.
If an applicant is homebound and has previously completed an Energy Assistance
Program application in the program year, no signature is needed for a subsequent
emergency application.
IV.3
CLIENTS WHO REQUEST HOME VISITS MUST BE SERVED WITHIN 60
CALENDAR DAYS OF THE REQUEST.
Mail-in applications occur when the LAA completes an application via telephone for the
homebound applicant. The LAA completes the top part of the application and a
documentation request form. Both forms, plus a self-addressed envelope, are sent to the
applicant who then signs and returns the application and documentation to the LAA for
verification. If the applicant cannot copy the documentation, refuses to send the
originals, or is not capable of understanding the mail-in procedure, a home visit will be
required.
Special Accommodations
Details for serving applicants with special needs must be worked out prior to the start of
the program. No application should be delayed because resources to assist the applicant
are not available. The following resources may be useful:
Deaf and Hard of Hearing Commission
217-557-4495 V/TTY
877-455-3323 V/TTY
Division of Rehabilitation Services
1-800-843-6154 English or Español
1-800-447-6404 TTY for callers who are
deaf or hard of hearing
IL Migrant Council
312-663-1522
Governor’s Constituent’s Assistance
Office
312-814-2121
Locations for Outreach/Intake
Permanent or temporary outreach sites should be located in all sections of the LAA’s
service area. They should be visible at the community level and be transportation and
building accessible to persons with disabilities. Possible outreach/intake sites may
include the LAA’s central and satellite offices, senior centers, nutrition sites, government
offices, churches or community facilities. Preference should be made for sites that
accommodate automated intake with LIHEAP.net.
If any organization other than the grant recipient provides outreach/intake services, it
must perform intake responsibilities according to the instructions in this manual. If these
services are free of charge, a Non-Financial Agreement must be signed by the Energy
IV.4
Assistance Program agency and the other organization. (Secure two signed copies of
every Non-Financial Agreement one for the agency file and one for the vendor’s file.)
If the agency has to pay for these services, a subcontract should be established and noted
in the agencies grant application; or if added later, reported to the Department in writing.
Scheduling Outreach/Intake
The agency must determine a time schedule for each outreach/intake site. The agency
must have this on file for review. Additions or changes should also be put in the file.
This schedule must demonstrate that clients of the agency’s entire service area have equal
access to program benefits.
Application/Eligibility
When all documentation is not presented at the time of application, this further delays the
application process. LAAs should stress in press releases and other contacts with
potential applicants that all documentation needs to be available at the time of the
appointment, including the actual or utility projected budget bill amount. However, all
households must be given the opportunity to apply, whether or not applicants have all the
necessary information with them at the time of application. Furthermore, the applicant
has 15 calendar days from the Documentation Request notice to provide the missing
documentation or be subject to denial after the Documentation Request notice due date
(or will be denied if funds are exhausted, whichever is sooner). A procedure letter to the
LAAs in April or May of each year will establish the last date LAAs may accept missing
documentation at the end of the program year (15 days may be shortened, due to other
program year close-out requirements).
The standard LIHEAP/IHWAP application should be used. The application includes a
page for additional household members’ information. If there are additional members in
the household besides the applicant, this sheet must be completed for the applicant, and
each additional household member, and each household member’s information must be
entered into the LIHEAP.net system.
WITHIN 3 DAYS OF APPLICATION DATE, ALL APPLICATIONS
MUST BE ENTERED INTO THE LIHEAP.net APPLICATION
SYSTEM.
Authorization To Apply
For households with a bill, an adult household member or emancipated minor must be the
Customer of Record with the energy vendor. If the Customer of Record cannot make
application, another household member may make application on his/her behalf. If the
person making application is not a member of the immediate household, the applicant
must provide a written statement to the agency designating the person to apply on his/her
behalf, and giving permission for the application to be signed by that person. If the
IV.5
person providing the application information is not the applicant, that person shall sign
the applicant’s name, then his/her own name and indicate his/her relationship.
In the case of an eligible household with no bill, the applicant should be the head of
household and should sign the application. If the head of household cannot make the
application in person, the same rules outlined above apply.
In child custody issues (a child is claimed in one household and the other parent
subsequently comes in to apply stating the child resides with him/her), the first family
member that claims the child and provides proof of the child’s social security card at the
point of intake – the child shall remain on this application.
Eligibility for Energy Assistance Program is limited to households at or below 150% of
the federal poverty income level. The income test is based on the household’s gross
income for the past 30 days, beginning with the date of application. Applicants are
required to show proof of the household’s gross income through various documents
and/or affidavits. A discussion of acceptable documentation to substantiate gross income
follows in Section V.
Client Confidentiality Rights
Agencies are reminded that information provided and secured about applicants is
confidential and obtained only for use by the Energy Assistance Program.
Client Appeals Rights
Federal and State rules require that every applicant be educated on their right to appeal.
Appellant rights for LIHEAP are printed on the reverse side of the client’s copy of the
application and agencies should review this section with the applicant. A copy of these
rights can be found in Section VI – Exhibits, along with the client application. Appeal
rights are exclusive to the definition of applicant household.
SECTION IV
INTAKE
EXHIBITS
Non-Financial Agreement Form .................................... IV.6
IV.6
ENERGY ASSISTANCE PROGRAM
Non-Financial Agreement
This letter of understanding is effected between the ___________________,
Local Administering Agency for the Energy Assistance Program, hereinafter
known as the “LAA” and _______________________, contributing agency,
hereinafter known as the “agency” on this day of ___________, 20___.
The agency agrees to provide the following as a public service to the LAA:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___________without expectation of compensation.
This agreement is in effect until: __________________________________
Signature __________________ Signature _________________
Date ______________________ Date _____________________
LAA __________________________ Agency __________________
SECTION V
DOCUMENTATION
SECTION V DOCUMENTATION
Income Documentation .................................................................................... V.1
Other Types of Documentation ........................................................................ V.9
Section V Exhibits ......................................................................................... V.15
V.1
SECTION V
DOCUMENTATION
Income and component-specific documentation are required to determine a client’s
eligibility for assistance. Intake staff should be aware of all required documentation. The
Application File Checklist form is a double check system for all applicant files because it
clearly lists the documentation required in the file. This form helps guide the intake
process. Using this Application File Checklist is optional. The Local Administering
Agency may choose to create their own checklist, or they may manage their files without
one.
The receipt of all required documentation determines the start date for the Energy
Assistance Program time frames. Therefore, all documents should be dated upon receipt
(handwritten or date-stamped) and the date must be entered on the appropriate line of the
LIHEAP/IHWAP application form, or in the documentation section on LIHEAP.net, as
documentation is received.
Income Documentation
For a complete application, gross income documentation and/or affidavits must be
provided for each person in the household who has received income during the previous 30
days (beginning with the date of application). Gross income (before taxes or any other
deductions) must be used to verify income with limited exceptions. The main exception is
Social Security checks that have a Medicare deduction.
For income documentation (wages, Unemployment Compensation Benefits, SSA, SSDI,
etc.) which clearly indicates Child Support garnishment, the gross minus the garnishment
amount should be used as countable income. In addition, households with documented
Child Support payments (such as cancelled checks, a statement from the recipient, other
documentation showing the payments were made, etc.) will have these amounts deducted
from gross household income. In situations where a fixed income has recoupment, for
Child Support, Internal Revenue Service (IRS), or other garnishment, net income should be
budgeted; use net income with the exception of included taxes (if applicable). If the LAA
ever questions whether gross or net income should be used for the Energy Assistance
Program application the Grant Manager should be contacted.
If a household is on a fixed income (income that does not change), it is preferable to verify
the income using the award letter if dated within the same calendar year. If a fixed
monthly income amount does not fall within the specific 30-day timeframe, do not enter
the client as a zero income applicant: the amount of the regular fixed income must be
included with the application (in STARS/LIHEAP.net, and/or in the applicant file).
Examples of fixed income include:
SSI
SSA
V.2
VA Benefits
DHS Payments (TANF, AABD, RRA)
Pensions
Acceptable types of documentation are:
Check(s) or copy of the check(s) for above described examples of fixed income
Check stubs (covering the 30 day period) that indicate payee, source, time period
and amount
Statement of a person who cashes the checks i.e., currency exchanges, banks,
grocery stores
Statement or affidavit from the source of the income such as employer, Social
Security Administration, Department of Human Services (or any State office),
Veterans’ Administration, Department of Labor, Township, etc.
Proof of electronic deposit or on-line verification by Intake Worker using Intake
Worker’s Documentation Affidavit
For SSA documentation, on the occasion when a benefit award letter and a current
bank statement don’t match, the bank statement amount should be used as the
countable income.
If an applicant does not have proof of gross income for the full 30 days, have the applicant
go to the source of the income(s) and have the source complete an Income Statement.
Provide forms for each source of income and have them returned directly to the agency by
the income source. Agencies may consider providing self-addressed stamped envelopes
for this purpose. If it is determined that the documentation, such as a check, cannot be
kept on file, either a copy should be made of the documentation or an Intake Worker’s
Documentation Affidavit should be filled out by the Intake Worker if it is not possible to
make a copy.
Multiple Applications
Verified income documentation will remain valid for 90 days. This policy is relevant if a
client returns to apply for additional Energy Assistance Program benefits. Additional
benefits are possible in the situations below:
A client, who previously received a DVP, returns for RA benefits.
A client, who previously received a DVP and a partial RA benefit, returns for
additional RA benefits to be paid to the other vendor.
A client, who previously received a DVP and/or RA, returns for Energy Assistance
Program Furnace Assistance.
If the client’s first application was made within the previous 90 days, income eligibility
will not need to be redetermined. However, the Intake Worker will need to sign and
include a copy of the Eligibility Verification form and/or a copy of documents from the
first application attached to the current application in the client’s file. The agency files
V.3
and/or LIHEAP.net are to be checked and the record of income duplicated on the current
application.
NOTE: At the discretion of the LAA, a client phone call to the LAA to report Imminent
Disconnection or Disconnection, with a dated affidavit from the LAA staff on the
Eligibility Verification Form, may suffice as an RA application. The client does not need
to reapply in person within the 90-day income eligibility period if the household situation
is unchanged since initial application date.
Zero Income Adult vs. Zero Income Household
Zero Income Adult - If there is any income in the home (child support, a child's Social
Security or Supplemental Security Income, etc.), one Zero Income Affidavit, which lists
each adult without income, must be completed by the applicant. The standard expectation
is the applicant will thoroughly complete the Zero Income Affidavit form his/herself. If
the client has vision, literacy and/or comprehension challenges, he/she may request the
LAA Intake Worker complete the form on his/her behalf. If the LAA Intake Worker
completes the form, the signature and initials of both client and Intake Worker are
required. If the adult(s) state(s) they are living off the child's income plus SNAP (Food
Stamps), subsidized housing, etc., then a written statement on the Zero Income Affidavit is
sufficient.
Zero Income Household - Households where every member included on the application
is claiming zero income must provide supporting documentation (for each adult claiming
zero income). The applicant will be required to complete and sign the Zero Income
Affidavit form for household members age 18 or older. Supporting documentation
examples include, but are not limited to at least one of the following:
Denial letter for Social Security benefits
Denial letter for Unemployment Compensation benefits
Denial letter for Workers’ Compensation benefits
Proof of application for Department of Human Services program(s) such as Cash
(AABD/ TANF/GA), Medical Assistance, and/or SNAP (Food Stamps)
The Verification of Assistance with Paying Household Bills form has been created
to facilitate consistent statewide efforts in documentation
Proof of Subsidized Housing
Note: The LAA Intake Worker and/or Verifier must consider the composition of each
household as unique and ask how that household lives on zero income. The head of
household and any other adult applicants need to explain how the family is meeting its
needs and what efforts there are to rectify the situation other than the Energy Assistance
Program.
If the zero income adult applicant states s/he cannot work because of disability, ask
if s/he has applied for disability and perhaps has a pending appeal and/or a denial
letter for benefits to provide as documentation. The LAA can recommend, or
V.4
require (if there is no other substantiating documentation), proof of application for
Social Security benefits.
If there is work history based on the last date of employment and the last check
date on the Zero Income Affidavit, inquire about the receipt of or application for
Unemployment Compensation Benefits (UCB). The adult may need to apply and
provide proof of application for UCB, or can give documentation of being denied
benefits, or can provide proof the benefits have recently been exhausted.
For an applicant stating s/he has been injured on the job and can't work, the LAA
can recommend, or require (if there is no other substantiating documentation), a
Workers' Compensation document for denied, exhausted, or ongoing benefits. A
doctor's statement within the past 90 days (beginning with the date of application)
that the client is not released for work may be appropriate substantiating
documentation.
Always inquire and recommend an application for DHS benefits (Medical, SNAP,
Cash assistance) if the household contains children. The LAA may require the
adult to prove application for benefits, provide proof of ongoing benefits, or
provide DHS denial letter.
Letter(s) of Support: If a Zero Income Household reports financial assistance with
bills from family members or friends, a “Letter of Support” may be provided by the
client to corroborate the statement. The Verification of Assistance with Paying
Household Bills form may be issued by the LAA for as many supporters from
whom the client receives assistance. For households who rely solely on such
support, the Verification of Assistance with Paying Household Bills form MUST
be received in a thoroughly completed status, or the application will be denied.
The LAA should also question the adult(s) about working for cash, doing odd jobs, yard
work, etc. Receiving cash for work performed is income. If the applicant attests to
receiving cash income, s/he can complete the Income Affidavit form. If the adult(s)
state(s) they are living on savings, the LAA may request a bank statement to show the bank
balance.
Department of Human Services
Cash payments from TANF, AABD supplemental payments, Transitional Assistance and
Refugee/Repatriate Assistance (RRA) are considered income. SNAP (Food Stamps),
medical assistance and cash payments made to providers on behalf of clients are not
income.
Recipients of TANF receive a Medical Eligibility Card. This card may be used to
determine the number of recipients in a family. However, an applicant should not be
denied if they cannot provide a copy of their medical card(s). Medical card(s) are not
required for Energy Assistance eligibility.
The DHS case ID number is divided in the following manner:
V.5
Category DHS Local Office Basic Number
00 000 000000
The type of aid received is indicated on the medical card by the category codes:
Cash Assistance Medical Assistance Only
00 RRA 90
01 AABD 91
02 AABD 92
03 AABD 93
04 TANF 94
06 TANF 96
07, P3 GA Chicago Only P# Outside City of Chicago
Due to the DHS change to an annual medical card (which no longer contains the DHS case
numbers, but it does contain each person’s “Recipient Identification Number, or “RIN”),
the applicant must complete the Income Affidavit. In addition, LAAs must use one or more
of the following resources to verify receipt of income from DHS:
1-Table of Monthly Allowances-
Use the Table of Monthly Allowances to compute the 30-day income figure for TANF and
RRA recipients who do not have any other income. If there is other income claimed by a
TANF or RRA recipient, the monthly income allowances charts alone cannot be used to
verify income.
If the TANF or RRA recipient states s/he is not receiving the amount indicated on the
Table of Monthly Allowances charts, the agency must obtain verification from the
Department of Human Services using the DHS Verification of Income form, toll-free
phone number in Section VII, the DHS website, and/or the client’s statement. For further
information see Section VII.4 “Contacting DHS to verify income.”
2- DHS Verification of Income-
Due to the fact that AABD cash recipients may receive a different amount each month,
LAAs must have the client complete the Income Affidavit. If the recipient does not know
how much they received, a DHS Verification of Income form (or other means of
verification) must be used.
3- DHS Website-
The following DHS website links http://www.dhs.state.il.us/page.aspx or https://ebt-
link.illinois.gov/ilebtclient/login.recip may be utilized to verify a limited amount of DHS
benefit recipient information.
V.6
Unemployment Compensation Benefits (UCB)
When an applicant has made an effort but is unable to provide all check stubs necessary to
document his/her unemployment compensation income for the 30-day period, use the
following procedure:
Copy the existing unemployment check stub(s) as documentation.
Ask the applicant to sign an Income Affidavit. Use this affidavit as documentation
for the missing check stub(s).
Do not count any Federal Supplement amount. Count and budget net UCB with the
exception of included taxes. Do not budget UCB “Deductions” (see UCB stub).
Use “Paydateon UCB stub as check date for paper check, or add two days to allow for
funds availability on a UCB debit card.
Interest
The preferred documentation is a statement for the previous 30 days (beginning with the
date of application) using either a bank statement or the Income Statement. If an applicant
can obtain only an annual statement, divide the income amount on the statement by 12 and
use it as the 30-day documented amount.
Self-Employment
Self-employed applicants who want to use expenses as part of their income calculation
should complete the Self-Employed Income Worksheet that will calculate net income.
Ledgers, check stubs, receipts or other verification shall be used as documentation, and
copies must be kept in the client’s file. Expenses should be counted at the time they are
paid. A Net Loss on the Self-Employed Income Worksheet may not be used to off-set
income from other sources within a household.
Other Income
The following are also considered income and require 30-day documentation:
Alimony
Strike benefits
Child Support
Rental income
Worker’s Compensation
Sick pay
Armed Forces allotments & allowances for housing, food and clothing (BAH on
paystub)
Tips and gratuities; money received over and above payment due for a service
Federal Black Lung Benefits
V.7
Annuities (a fixed sum of money paid to someone each year, typically for the rest
of their life; divide by the appropriate number to get a monthly amount when
applicable)
Cash gifts (may be verified via Income Affidavit)
Any income received for support of guardian and/or adopted child(ren)
Educational Stipends (a periodic payment, especially a scholarship or fellowship
allowance granted to a student)
Regular payments of an IRA (Individual Retirement Account) should be considered
income just like a pension
Gambling proceeds and/or annual gross income should not exceed the annual 150%
income eligibility
A one-time lump sum payment of lottery winnings must be divided by 12 months
to equal the 30 day income requirement
Rental income is counted if applicant rents property outside his/her own household
or applicant shares his/her home, i.e., one household unit with a boarder, lodger
and/or renter who is NOT related
DO NOT DEDUCT ANY EXPENSES THE APPLICANT MAY CLAIM
FOR OPERATING THE PROPERTY, e.g., HEATING COSTS,
MAINTENANCE, etc.
DO NOT COUNT RENTERS AS HOUESHOLD MEMBERS OR
INCLUDE THEIR INCOME IN THE HOUSEHOLD’S INCOME
Social Security income received for a spouse that resides in a nursing
home/assisted living facility that is not paid directly and completely to the facility
is countable income for the LIHEAP household"
Other income, such as income from selling farm crops or livestock or similar bulk
product once a year, must be divided by 12 months to equal the 30 day income
requirement
Commission checks that cover more than one month should be divided by the
appropriate number of months to equal the 30 day income requirement
The following are not considered income:
Payments for Vocational Rehabilitation transportation and maintenance
Reimbursement for other expenses incurred (such as for medical expenses)
Payments made to others on the household’s behalf provided that such payments
were not directed by the household i.e., bills paid or purchases made by others
Scholarships, subsistence amounts (BAS on paystub; an allowance paid to
Veterans while they pursue an educational or training program), GI Bill benefits
Federal student aid (Grants or loans to undergraduate students made or insured
under programs administered by the Department of Education)
Assets drawn down as withdrawals from a bank (or other financial institution);
such as, individual savings accounts, Reverse Mortgage, etc.
Loans (including Student Loans)
Sale of property
Sale of house or car
V.8
Sale of household items/assets at yard sales, on E-Bay, etc. is not income but is
proof of how all or part of the household’s monthly expenses were paid
Tax refunds, including Earned Income Tax Credit (EITC) payments, whether
received as an advance payment with wages or as part of an income tax refund
Gifts – in the form of non-cash assistance, i.e. food, clothing, rent, etc.
One time insurance payments or compensation for injury
Non-cash income
One time payments e.g., Death Benefits, Circuit Breaker Benefits, Jury Duty,
retroactive child support, SSI, SSA, UCB, etc.
Foster Grandparents/Senior Companion Stipend (Note: Do not count children as
household members); any payment to volunteers in programs under Title II of the
1973 Domestic Volunteer Services Act. Examples of these programs include RSVP
and Foster Grandparents
Title V Senior Temporary Training Program; payments received from the
Community Service Employment Program funded under Title V of the Older
Americans Act (such as the Experience Works Program, formerly called Green
Thumb)
Foster Parent Reimbursement (Note: Do not count children as household
members)
Payments made under Title I of the 1973 Domestic Volunteer Services Act
(AmeriCorps VISTA, University Year for Action and Urban Crime Prevention
Program) are exempt if the person was receiving SNAP or cash benefits from
TANF, GA, or AABD at the time they joined AmeriCorps VISTA. (A temporary
interruption in SNAP/Food Stamps does not change the status of exempt
AmeriCorps VISTA payments.)
SNAP benefits (Food Stamps)
Income from employment through Title I, Workforce Innovation and Opportunity
Act (WIOA), including Job Corps
Women, Infants, and Children Supplemental Nutrition Program (WIC) benefits
Earned Income of dependent minors (children under 18 years of age)
Reimbursements from the Uniform Relocation Assistance and Real Property
Acquisition Policy Act of 1970
Earnings, allowances, and payments received under Title I of the National and
Community Service Act of 1990 are exempt. The programs in the act are:
Serve America,
Higher Education Innovative Projects,
American Conservation and Youth Corps Programs,
Community Service Programs, and
AmeriCorps State/National
Any disaster relief payment made by federal, state, or local government, or by a
disaster assistance group
Utility payments from a Public Housing Authority, whether paid directly to the unit
or to the utility company
Payments to certain United States citizens of Japanese ancestry and resident
Japanese aliens and certain eligible Aleuts made under P.L. 100-383
V.9
Payments under P.L. 103-286 to persons due to their status as victims of Nazi
persecution
Payments made to Veterans who receive an annual disability payment or to the
survivors of deceased Veterans who receive a onetime, lump sum payment from the
Agent Orange Settlement Fund or any other fund referring to Agent Orange
product liability under P.L. 101-201
Money received from the Social Security Administration under a Plan to Achieve
Self-Support (PASS)
Payments received under the Alaska Native Claims Settlement Act
Additional payments received by military personnel for serving in a combat zone
Monetary allowances for certain children of Vietnam War veterans (children born
with the congenital defect spina bifida and with certain birth defects)
Tribal per-capita payments up to $2000 per person, per year, including payments
made out of income from tribal lands, payments made out of tribal judgment trust
funds, and any other source except gaming revenues
Income derived from certain submarginal land of the United States that is held in
trust for certain Indian tribes
Income received from the disposition of funds to the Grand River Band of Ottawa
Indians
Payments by the Indian Claims Commission to the Confederated Tribes and Bands
of the Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation
Payments to the Passamaquoddy Tribe and the Penobscot Nation or any of their
members made under the Maine Indian Claims Settlement Act of 1980
Payments of relocation assistance to members of the Navajo and Hopi Tribes made
under P.L. 93-531
Matched funds that are deposited into an Individual Development Account (IDA)
from a unit of state or local government or through contributions made by a not-
for-profit entity are exempt income - funds deposited into the IDA remain exempt
as long as the IDA is maintained
Payments made through the Victims of Crime Act of 1984
Payments made under the YouthBuild Program (P.L. 102-550)
Veteran’s Administration Pension Benefits for Aid and Attendance
Life insurance proceeds (whether made in installments OR paid upfront)
Money received from a Reverse Mortgage (but it can be used as proof of “regular
monthly support” for Zero Income applicants)
One time withdrawal from 401K or retirement funds
Income from work study programs
National School Lunch Program (NSLP) free or discounted lunches
Other Types of Documentation
All applicants must provide a valid Social Security Number (SSN) in addition to income
documentation. A valid SSN is defined as a nine-digit number issued to U.S. citizens,
permanent residents, and qualified temporary residents by the Social Security
Administration.
V.10
Three different types of Social Security cards are issued. The most common type contains
the cardholder’s name and number. There are also two other valid types of Social Security
cards used with the original purpose of tracking individuals’ accounts within the Social
Security program:
One reads “NOT VALID FOR EMPLOYMENT”
The other reads “VALID FOR WORK ONLY WITH DHS AUTHORIZATION”
(DHS – Dept. of Homeland Security)
Depending on the situation and type of benefit applied for, various other kinds of
documentation will also be needed. A description of the types of documentation used for
Energy Assistance Program intake follows. Head of household clients’ applications with
invalid Social Security numbers will be denied. Household members over the age of one
will also be required to have a valid SSN to qualify. NOTE: Each applicant must be a
resident of Illinois and either a U.S. citizen or a “qualified alien” as detailed in Section I of
this manual. LIHEAP HHS Information Memorandum published December 12, 2014
states: The income of all household members regardless of eligibility must be
documented, verified, and included in the calculation of the LIHEAP benefit amount.
Child Custody/Energy Assistance Application
When a child is claimed in one household and the other parent or family member
subsequently makes application stating this child lives in his/her household, the child shall
remain on the application of the first family member that claims the child as long as they
have provided proof of the child’s Social Security card at the point of intake.
Legal Names
For a new applicant or existing customers whose name does not match the Social Security
card and/or the utility customer of record, any of the following documents are acceptable
documentation for verification of a legal name:
Social Security cards
Driver’s License or Government-issued Photo ID
Court documents
Divorce papers
Certificate of Marriage
The Affidavit of Legal Name(s) should be used to document a client’s use of more than
one name. This form links together a person with multiple variations of the same name.
All names (variations thereof) belong to the same person.
Social Security Numbers
The Intake Worker must ask the applicant for the Social Security numbers for all
household members. Hard copy proof must be obtained and may include a copy of the
Social Security card itself, a letter or print out from Social Security Administration, or any
V.11
other form of government-issued identification that shows both name and Social Security
number. A TIN (Temporary Identification Number) is not an acceptable form of Social
Security documentation.
Social Security numbers of household members other than the applicant are to be collected
for data entry into LIHEAP.net; copies of Social Security number verification must be
included in the application file.
If the applicant does not have a social security number:
1. complete the application,
2. issue a Documentation Request Form for the missing Social Security number, and
3. encourage and assist the client in obtaining a Social Security number.
A documented Social Security number is required. For situations, such as I-360
PETITION, contact your Grant Manager so applicant eligibility can be arranged, when
possible.
LAAs must refer applications with fraudulent SSN(s) to the OEA Grant Manager. After
review, if enough evidence to support the suspicion of fraud is provided, the Energy
Assistance Program Manager may disqualify the household or individual members and
begin the recoupment process as described in Section VII, Correction of Client Benefit
Errors.
Proof of Responsibility for Energy Consumption
All applicants who pay their energy bills directly to the vendor must have a copy of one of
the following:
Most recent primary and/or secondary energy bill
Most recent bill stub/receipt
Statement from the primary and secondary vendor
An affidavit by the Intake Worker that one of the above materials has been
examined
The above must include Customer of Record name (adult household member or
emancipated minor name), address, account #, and rate code (if applicable). Only
residential, not commercial, accounts are eligible to receive Energy Assistance Program
benefits.
Good Faith Effort
To be eligible for Energy Assistance (DVP and/or RA), a disconnected or imminently
threatened client must make a Good Faith Effort toward paying his/her utility bill(s),
including payment of all Client Portion Required balances.
If the applicant’s payment history does not demonstrate good faith, the applicant will be
required to pay a $75 Good Faith Effort (GFE) payment to the utility or utilities that would
V.12
receive LIHEAP payments(s). Applicants may owe additional past due amounts above the
required $75; this balance is the Client Portion Required (CPR). All GFE/CPR payments
must be made in full prior to receiving any Energy Assistance benefit (DVP or RA).
The Department of Commerce and Economic Opportunity will implement the Good Faith
Effort (GFE) /Client Portion Required (CPR) requirement as follows:
DCEO and/or the LAA will look at the LIHEAP applicant’s payment history. If the
application includes both utilities or if the electric utility is the primary vendor, then the
client payments to vendor(s) in the previous 90 days (beginning with the application date)
must be at least 10% of the 30-day household gross income multiplied by 3. If the
payment history does not demonstrate the required percentage of payments has been made,
then the applicant will be required to pay a GFE and/or CPR.
The preferred method of payment for the $75 is cash or money order at the utility’s
authorized payment center, however receipts from other forms of payment should also be
accepted. If the applicant presents a receipt to verify his/her GFE/CPR payment, the LAA
will enter/save into LIHEAP.net: 1. the total amount paid, 2. the receipt
number/transaction number and date of the payment. The LAA will then continue
processing the application. Or, if a utility reports through LIHEAP.net that the GFE/CPR
payment has been made, the LAA can continue processing the application. The LAA must
enter the exact payment amount made by the client towards their GFE/CPR, instead of
entering only $75. LAAs must negotiate the restoration of service as much as possible.
Regulated utilities are required to comply with the Illinois Public Utilities Act as amended
(Illinois Administrative Code 280) regarding reconnection of service to Energy Assistance
Program households.
IMPORTANT NOTES:
1. If the utility has put the client’s deposit refund onto the final account - this is money
that would go back to the client, if they were still in good standing with the utility. If
the utility will agree to transfer the deposit amount onto the new, or reconnected
account, this may be used to satisfy the GFE/CPR payment requirement. The entire
amount of the deposit refund payment must be counted as the GFE/CPR payment (i.e.,
if the refund is $250, that’s the GFE payment amount, not $75).
2. No GFE/CPR payment receipt should be dated prior to the application date.
At the discretion of the LAA, a client phone call to the LAA with the GFE/CPR receipt
number is acceptable, especially for electronically communicating utilities.
The applicant has 15 calendar days from the GFE/CPR notice to pay the required amount
or be subject to denial after the appropriate deadline (or will be denied if funds are
exhausted, whichever is sooner). A procedure letter to the LAAs in April or May of each
year will establish the last date LAAs may accept missing documentation at the end of the
program year (15 days may be shortened, due to other program year close-out
requirements).
V.13
The Good Faith Effort may be waived with written permission from the Office of
Energy Assistance only in cases of extreme economic hardship, or when the applicant
did not have any previous primary and/or secondary service accounts during the past
90 days (starting with the application date) or has paid such bills in full. Extreme
economic hardship exists when the household’s source of income (that income that
would have been used to determine income eligibility) has been permanently
terminated for at least 30 days and a new source of income has not commenced.
Documentation of this condition must be received and verified by the agency before
the Reconnection Assistance payment may be processed. The GFE may be waived in
these specific instances; the CPR may never be waived. The client should make other
arrangements for payment of the CPR.
It is the responsibility of the applicant to provide documentation of payments made to the
energy vendor(s). Documentation includes:
Cancelled checks(s)
Receipt(s) for payment
Vendor verification
Copy of bills indicating payment(s) received either as a separate item or an obvious
reduction in the amount owed. Payment reductions cannot be due to state energy
assistance payments(s)
Telephone verification with utility
The agency may wish to use the Reconnection Assistance form to assist with the
documentation process. It may be helpful to utilize this form to verify restoration amounts
from the energy vendor(s). Only residential, not commercial, accounts are eligible to
receive Energy Assistance Program benefits.
Rent Amount Verification
If the applicant does not have energy bills because energy costs are included in the rent
payment, the household must prove its monthly rent costs are greater than 30% of the
household’s gross income for the previous 30 days (beginning with the date of
application). If the client cannot provide adequate documentation to prove monthly rental
expense, the Rent Amount Verification form should be utilized. The form allows for
confirmation of the rent amount by the landlord or building manager. If the agency
chooses, it may call the landlord for the client to obtain the necessary verification. The
Rent Amount Verification form must still be utilized and included in the client file.
V.14
Documentation Request Form
If all the documentation is not provided as listed, LIHEAP.net and/or the Intake Worker
will provide the applicant a Documentation Request form indicating in writing the
documentation that the applicant must provide and the date when it must be provided.
Allow 15 calendar days from the determination date that further information is needed to
process the application. An explanation of the Documentation Request form must be given
verbally to all applicants. A copy of the form provided to the applicant must be in the
applicant’s file. If the urgency of the application status does not allow for the
Documentation Request form and/or GFE/CPR letter to be sent, and the LAA handles the
client notification via phone or in person, then the method and details of the client contact
must be documented in the file and/or in the LIHEAP.net App Comments section.
Medical Certification and/or Cooling Medical Condition - LAAs will not operate a
Summer Energy Assistance Program in the 2016 program year.
The household must contain at least one member experiencing an existing serious medical
condition that would be aggravated by disconnected energy service in accordance with ICC
regulations found in 83 Illinois Admin. Code 280.130. If a customer is on a Medical
Equipment Register (MER) (use electric for life-support equipment), a Cooling Medical
Condition may be verified through use of a utility portal (if available) or by a phone call
affidavit with a utility representative. If the customer is not on the MER, the existence of
serious medical condition(s) must be certified by a licensed medical practitioner. The
medical condition documentation/certification must be dated within one year of the date of
application.
For the Energy Assistance Program Summer Cooling applications the medical condition
documentation/certification must be dated within the past 90 days, beginning with the date
of application. Medical persons from whom this certification can be accepted are limited
to:
Any physician licensed in accordance with the Medical Practice Act of 1987 or
licensed in an adjoining state, or
Public health officials who are medical persons (i.e., licensed physicians or
licensed registered or licensed practical nurses acting as a representative of a
physician) associated with the National Health Service, the Illinois Department of
Public Health, a county health department, or a city or township health department
Once the medical practitioner has determined a serious medical condition exists, he/she
should complete the Cooling Medical Condition form. If the applicant has a statement
from a medical person that contains identical information i.e., name and address of the
household member with condition, a description of the condition, the period of time during
which termination of energy services will aggravate the illness, signature and title of
medical person, then such a statement is acceptable. When filed, it must be attached to the
Medical Certification form.
SECTION V
DOCUMENTATION
EXHIBITS
Application File Checklist ...............................................................................V.15
Income Statement .............................................................................................V.16
Eligibility Verification Form ...........................................................................V.17
Zero Income Affidavit ......................................................................................V.18
Verification of Assistance with Paying Household Bills ..................................V.19
Intake Worker’s Documentation Affidavit ......................................................V.20
TANF Table of Monthly Allowances ..............................................................V.21
DHS Group I, II, & III Counties List ................................................................V.22
DHS Verification of Income .............................................................................V.23
Income Affidavit ...............................................................................................V.24
Self-Employed Income Worksheet ..................................................................V.25
Reconnection Assistance .................................................................................V.26
Documentation Request ....................................................................................V.27
Rent Amount Verification ................................................................................V.28
Cooling Medical Condition ..............................................................................V.29
Affidavit of Legal Name(s) Form ..................................................................V.30
V.15
APPLICATION FILE CHECKLIST
AppID:
Agency Name:
Program Year:
Intake Site:
County:
Household Members
App Date:
HOH
Name
Age
Birth Date
SSN
30-Day Income
All Energy Assistance
Documentation
Furnace Documentation
Furnace Documentation
Cont...
Thoroughly completed and signed
Energy Assistance application.
Proof of Ownership
Furnace Assessment Worksheet
Proof of 30-day income for all applicable
household members or Zero Income
Affidavits & Supporting Docs.
Building Owner Work Authorization
form (for each homeowner)
Justification for Replacement vs.
Repair
Proof of Social Security number for all
household members
Detailed Contractor's Invoice
including all parts and labor
Furnace page from LIHEAP.net
(with activity history)
Most recent utility bill (s)
Sizing Chart (for all replacements)
Additional Documentation
(when necessary)
Benefit Summary
Contractor Assurance & Guarantee
of work with dates
Rent verification (when necessary)
Explanation when 80% Furnace is
installed
Document Request form (when
necessary)
Final Inspection Form
Good Faith Effort and/or Client Portion
Required Documentation (when
necessary)
Contractor Checklist
Intake Worker
Energy conservation. For clients with high energy consumption, I have provided information that may help reduce
their overall energy costs.
Weatherization. I offered homeowners the option to apply & renters were given the brochure to discuss with their
landlord. I also explained that we cannot re-weatherize their home if the home has been weatherized since September
30, 1994. (This includes if their home was weatherized prior to them moving in.)
I explained the notification of assistance and/or denial procedures.
I advised the client to continue to pay all utility bills.
I explained the payment procedures.
I explained the hearing & appeal process, & provided a copy of the Client’s Rights form.
Intake Worker Signature* __________________________________________ Date:________________
Verifier Signature * _______________________________________________ Date:________________
* This is an optional form. If this form is used, at least one of these signatures is required.
V.16
ENERGY ASSISTANCE PROGRAM
INCOME STATEMENT
Wages, Social Security, etc. ______________________________________________
Person, Company or Agency ______________________________________________
Street Address, City, State, Zip ______________________________________________
To whom it may concern:
Re: ________________________________
Applicant Name
I hereby authorize the above person and/or agency to provide verification as provided below of my gross income from
_____________________________________for the past 30 days
Income Source
as part of my application process for the Energy Assistance Program. I understand that noncompliance with this request
for income information may result in the denial of assistance.
I understand that to perjure myself in order to obtain assistance is a fraudulent offense for which I can be
prosecuted.
Signature: ___
Applicant’s Social Security # : ___
Address: _________________________________________
_________________________________________
Please mail or deliver to:
Name _____________________________________ received the following gross income from
_________ ___ for the past 30 days, / / to / / $ ______
Income Source
Did the person work the entire 30 days? Yes No N/A
Signature_____________________________ Title________________________________
Phone Number________________________ Date_______________________________
V.17
ENERGY ASSISTANCE PROGRAM
ELIGIBILITY VERIFICATION FORM
APPLICANT NAME
SOCIAL SECURITY NUMBER
APPLICATION ID # (less than 90 days old) __________________________________________
ELIGIBILITY DOES NOT NEED TO BE REDETERMINED:
I have checked agency files and/or THE DEPARTMENT computer records. These records verify the above-
named applicant household was determined Energy Assistance Program eligible within the previous 90 days.
I have duplicated this record of income on the client’s current application #__________________
Intake Worker Signature Date
Energy Assistance Program
Zero Income Affidavit
Income period
From ________________
To ________________
Name of adult members with
Zero Income:
Last date of
employment:
Date of last pay:
Application #:
Head of Household:
1. Did you receive cash for work performed in the last
30 day
s?
Yes* No
*Example: braiding hair, babysitting, lawn/snow maintenance, car repair, scrap metal,
etc. If
yes, complete the Income Affidavit form and/or the Self-Employed Worksheet to report this
income.
2. List any money received from family, friends, or donations in the
30 days
specified:
Amount
Gift or Loan
Amount
Gift or Loan
Amount
Gift or Loan
Amount
Gift or Loan
3. Please explain below how the following expenses have been met in the household:
Food
Housing
Transportation
Utilities
Basic living
needs*
*Example: clothing, diapers, cleaning supplies, personal hygiene products, etc.
I certify that the information provided above is true and complete statements of facts. I
also understand that I may be required to provide proof of any information given and that giving
false information will invalidate this form, and may require the return of any benefits received
based on the false information.
Assistance was needed to fill out this form: ___Applicant Initials ___Intake Worker Initials.
Applicant Signature Date
Intake Worker Signature Date
V.18
V.19
ENERGY ASSISTANCE PROGRAM
Verification of Assistance with Paying Household Bills
To Whom It May Concern:
I, ______________________________, have paid the following expenses for
(Print first and last name)
_______________________________, from _____________ to __________
(Applicant’s name) (Start date) (End date)
Please fill in the dollar amount that applies:
$________ Heat/Electricity
$________ Rent
$________ Food
$________ Water
$________ Transportation
$________ Other Please detail: ______________________________________
_____________________________________________________________________
$________ TOTAL
I understand that to perjure myself in order to obtain assistance is a fraudulent offense for which I can be
prosecuted.
Name: ______________________________ ____________________
(Signature) (Date)
Address: ________________________________________________________
Phone Number: _________________________
THIS FORM MUST BE RETURNED BY: _____________Application Number: ________
V.20
ENERGY ASSISTANCE PROGRAM
INTAKE WORKER’S DOCUMENTATION AFFIDAVIT
Intake Worker _____________________________________ Date ________________________
Agency_______________________________________________________________________
I, the undersigned, attest that I have seen the following documents supporting the information presented by:
Name _______________________________________________________
Address _______________________________________________________
_______________________________________________________
as applicant for assistance under the Low Income Home Energy Assistance Program.
Document (s):
Name ____________________________ Name _______________________________
Date (s) _____________ to___________ Dates (s) ___________ to _______________
Item Amount ______________________ Item Amount _________________________
Name ____________________________ Name _______________________________
Date (s) _____________ to___________ Dates (s) ___________ to _______________
Item Amount ______________________ Item Amount _________________________
Additional Data: (Identify) e.g., Account Numbers, Bank/Employer/Utility Name, Address, Phone Number, etc.
______________________ _______________________
Signature of Intake Worker Date
V.21
DHS: WAG 25-03-05
TABLE OF MONTHLY ALLOWANCES
TANF PAYMENT LEVELS
# IN
UNIT
GROUP I
CHILD
ONLY
GROUP I
ADULT &
CHILDREN
GROUP
II
CHILD
ONLY
GROUP II
ADULT &
CHILDREN
GROUP
III
CHILD
ONLY
GROUP III
ADULT &
CHILDREN
1 117 243 111 233 108 198
2 230 318 222 307 215 294
3 284 432 277 417 271 399
4 365 474 356 461 346 445
5 434 555 422 540 411 519
6 465 623 455 605 443 585
7 501 657 488 638 474 616
8 536 691 525 673 509 647
9 576 727 562 709 546 683
10 616 765 601 746 584 718
11 659 807 642 784 623 758
12 703 848 686 825 665 797
V.22
Group I
County List
Group II County List Group III County List
Boone Adams JoDaviess Moultrie Alexander Gallatin Massac Union
Champaign Bureau Knox Peoria Bond Greene Menard
Washington
Cook Caroll LaSalle Piatt Brown Hamilton Montgomery
Wayne
DeKalb Clinton Lee Putnam Calhoun Hancock Perry White
DuPage Coles Livingston Rock Island Cass Hardin Pike Williamson
Kane DeWitt Logan Sangamon Christian Henderson Pope
Kankakee Douglas Macon St.Clair Clark Jasper Pulaski
Kendall Effingham
Macoupin Stephenson Clay Jefferson Randolph
Lake Ford Madison Tazwell Crawford Jersey Richland
McHenry Fulton McDonough Vermilion Cumberland Johnson Saline
Ogle Grundy McLean Wabash Edgar Lawrence Schuyler
Whiteside Henry Mercer Warren Edwards Marion Scott
Winnebago Iroquois Monroe Will Fayette Marshall Shelby
Woodford Jackson Morgan Franklin Mason Stark
V.23
(Please type or print) Date ______________________
To: Illinois Department of Human Services
Inquiry and Referrals
425 S. 4
th
Street
Springfield, IL 62701
DHS VERIFICATION OF INCOME
LIHEAP Applicant Name: _______________________ SS# ________________ RIN: ________________
DHS Recipient Name: __________________________ SS# ________________ RIN:_________________
(RIN = Recipient Identification Number)
DHS Case Number (If Known)_______________________________________________
Household Address: ___________________________________
___________________________________
Please provide verification of above recipient’s public assistance payments for the past _______ days and/or _________
months, beginning with the period _________________ as part of the application process for IHWAP, LIHEAP and
CSBG eligibility determinations.
Please return this form to:
______________ / _________________ / __________________
LAA Number Telephone Contact
Due Date: __________________________ / ___________________________
LAA Address:
-------------------------------------------------
-------------------------------------------------
-------------------------------------------------
-------------------------------------------------
===============================================================
DHS USE ONLY
PUBLIC ASSISTANCE PAYMENTS
MAIL DATE
Day/Month/Year
____________ _________ __________ ____________ __________ ____________
____________ _________ __________ ____________ __________ ____________
____________ _________ __________ ____________ __________ ____________
____________ _________ __________ ____________ __________ ____________
_______________________________ __________________________ ______________
Signature Title Date
Child Support
GA
TANF Pass Through AABD RRA
(DHS only)
V.24
ENERGY ASSISTANCE PROGRAM
Income Affidavit
Application Name: _______________________ County: ___________________ Application Number: ________________
I, ________________________________________________________, attest to the fact I have received
$___________ gross income for the period covering __________________ to _________________.
I met my financial obligations during the 30-day period by:
__________________________________________________________________________________________
____________________________________
DHS INCOME CHECKLIST
Does your household receive Food Stamps/SNAP Benefits? Yes ________ No _________
If yes, how much? $________________
Does your family have a Medical Card(s)? Yes ________ No _________
Does your family receive AABD or TANF funding? (Please circle which one) Yes ________ No _________
If yes, how much? $________________
INTAKE/VERIFICATION NOTE: Use DHS Table of Monthly Allowances chart. If the amount differs
from the chart, the client MUST have proof of current DHS income. (Refer to Section VII contacting
DHS to verify income)
__________________________________________________________________________________________
I understand that to perjure myself in order to obtain assistance is a fraudulent offense for which I can be
prosecuted.
________________________________________ ____________________________
Applicant Signature Date
Intake Worker or Verifier’s Signature:_____________________________ Date:___________________
V.2
SELF-EMPLOYED INCOME WORKSHEET
Applicant/Household Member Name___________________________________________________________
Business Address__________________________________________________________________________
Type of Business___________________________________________________________________________
Information must be verified by a ledger, check stubs, receipts and/or other verification.
A. GROSS RECEIPTS OR SALES
B. DEDUCTIONS OF EXPENSES RELATED TO BUSINESS
1. Advertising (flyers, newspaper ads, etc.)
2. Bad debts from sales or service (uncollectable)
3. Bank Service Charges ( bank fees)
4. Business Related Laundry (uniforms,)
5. Cost of Goods Sold (cost of products sold)
6. Insurance (for business only)
7. Interest on business indebtedness (loans, credit cards, etc)
8. Legal and Professional Services (accountant, lawyer, etc)
9. Office Expense (copy paper, pens, sales receipts, etc)
10. Postage(mailing flyers, invoices, receipts, etc)
11. Rent Expense(for business property - does not include mortgage)
12. Repairs (on copy machines, fax machines, computers, etc)
13. TaxesŝŶĐƵƌƌĞĚĂŶĚƉĂŝĚĚƵƌŝŶŐƚŚĞƚŝŵĞĨƌĂŵĞ (business related )
14. Telephone (business related)
15. Transportation Expense (use business miles - IRS 201ϱ - $.57 per mile for automobile) or
public transportation (bus, train, taxi)
16. Utilities (business)
17. Wages Paid to Employees (Other than Self or Household Members)
18. Other(specify)
C. Wages paid to Owner
D. Wages Paid to Household Member
E. TOTAL EXPENSES (B + C + D)
F. NET INCOME A. (GROSS RECEIPTS) minus E. (EXPENSES) = NET PROFIT OR LOSS
*** C, D, and F must be reported on income affidavit
1. The Profit or Loss (listed above) from business or professional self-employment is for the 30 day period
of________________________ to ________________________.
2. The Profit (or Loss) list above is available to the owner and/or other household members for personal use?
Yes No
3. I certify and declare, under penalties of perjury, that the information I have provided is an accurate and
complete disclosure of the requested information.
Signature__________________________________________________Date______________________
V.26
RECONNECTION ASSISTANCE
Client Name ___________________________________________ Date ____________________
Outside Temperature _________
DISCONNECT VERIFICATION
Primary
Secondary
Name of Utility
Contact Person
Date of Disconnection
Current Bill
Old Bill
Deposit
Total Utility Amount
Owed
Total to Reconnect
- GOOD FAITH WORKSHEET -
Amount Client Paid
in last 90 days
Date
Primary
Date
Secondary
90 Day Time Frame:
______ : ______
TOTAL PAID
________
________
________
________
$ __________
$ __________
$ __________
$ __________
$ __________
______________
______________
______________
______________
$ __________
$ __________
$ __________
$ __________
$ __________
Household 90 day
income:
10% of 90 day
income
Total utility amount
owed
Both Utilities
7% income Gas
Client paid in last 90
days
Both Utilities
3% income Electric
- RECONNECT WORKSHEET
$ _________
Max. RA
$ _________
Primary RA Needed
$ _________
Balance RA
$ _________ Secondary
RA
Needed
$ _________ Balance
Total needed for reconnect
DVP
Client must pay GFE
Total of RA due Utility
Client excess due Utility
Amount Client paid
Verified by whom @ Utility
Verbal Notification
Reconnection Date
Utility Representative
Primary
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
Secondary
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
$ ___________
Staff Signature
*****If the reconnect section is not completed, a receipt must be in the file. *****
V.27
ENERGY ASSISTANCE PROGRAM
DOCUMENTATION REQUEST
A copy of this form must be in the client file anytime documentation is requested
Applicant’s Name _____________________________ Date ________________________
Application ID# ______________________ Social Security # _____________________
The following documentation is needed before your application
can be processed:
INCOME INFORMATION:
1. Social Security Administration Income
2. Supplemental Security Income
3. Department of Human Services Income (TANF, AABD, GA)
4. Unemployment Benefits
5. Pension
6. Income Documentation from ____________________________________
7. Income Documentation from ____________________________________
(Note: Check stubs must include payee, source, time period and amount)
8. Savings and/or checking account
OTHER NEEDED INFORMATION:
9. Affidavit – Reason: ____________________________________________
10. Social Security Number (s) for: __________________________________
11. Consent of Disclosure
12. Rent Amount Verification
13. Copy of Utility/Fuel Bill: Primary Secondary
14. GFE/CPRVerification of Payment to Utility
15. Resident Alien Documentation
16. Other information – Specify: ___________________________
The above information must be received in the Agency office at: _________________________
On or before _____________________ , 20___.
I understand that noncompliance with this request for information may result in the denial of assistance.
I understand it is my responsibility to obtain the required information.
Applicant Signature Date
Intake Worker’s Signature Date
PLEASE RETURN THIS FORM WITH THE REQUESTED DOCUMENTATION
V.28
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM
RENT AMOUNT VERIFICATION
Applicant’s Name ________________________________________________
Address ________________________________________________
________________________________________________
Application ID# __________________________
Telephone Number (_____)_____________________
Landlord/Manager Name ________________________________________________
Address ________________________________________________
________________________________________________
________________________________________________
Telephone Number (_____)___________________________________________
What dollar amount of rent is charged to applicant per month? $__________________
Are utilities included in the rent? __________________________________________
Landlord/Manager Signature _____________________________________________
Date _________________________________________________________________
Please mail or deliver to: _______________________________________________
_______________________________________________
_______________________________________________
By Date: ________________________________________________
LAA VERIFICATION (if applicable)
LAA Verified Signature ________________________________________________
Date Landlord/Manager contacted (if needed) __________________________________
V.29
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM
COOLING MEDICAL CONDITION
Please fill out this statement and return to the following address:
I certify that ________________________________________________ suffers from an existing serious
condition which necessitates a continuous supply of home energy.
Illness or medical condition: ________________________________________________
__________________________________________________________________________________________
________________
__________________________________________________________________________________________
________________
Period of time during which termination of energy services will aggravate illness: _______ to ________
Signature _______________________ Print Name_____________________________
Name of Title/Degree ____________________________________________________
Practice or Organization Name _____________________________________________
Registration Number _____________________________________________________
Phone Number _____________________________________________________
I hereby authorize this agency to verify that information provided by me and to contact my physician or
other public health official for the purpose of securing medical certification as described above.
____________________________ _________________________ _____________
Name of Applicant Signature of Applicant Date
Social Security Number of Applicant _____________________________________
Return form to:
_________________________________
_________________________________
_________________________________
V.30
ENERGY ASSISTANCE PROGRAM
Affidavit of Legal Name(s)
I, ___________________________________, certify that I’ve been known by the name(s)
listed below. I further certify that the names are legal and belong to me.
_________________________________ ___________________________
Print Name (known by) Print Name (known by)
I understand that to perjure myself in order to obtain assistance is a fraudulent offense for which
I can be prosecuted.
_________________________________
Signature
_________________________________
Date
SECTION VI
APPLICATION INSTRUCTIONS
SECTION VI APPLICATION INSTRUCTIONS
Application Instructions ....................................................................................VI.1
STARS ..............................................................................................................VI.2
LIHEAP/IHWAP Application ..........................................................................VI.3
Vendor Information ..........................................................................................VI.6
Alternate Billing Information on LIHEAP.net .................................................VI.7
IHWAP Eligibility Section of the LIHEAP/IHWAP Paper Application..........VI.9
Section VI Exhibits ........................................................................................VI.12
VI.1
SECTION VI
Application Instructions
No applications are to be solicited, completed, or appointments scheduled prior to the
program start date.
It is the responsibility of a household to make themselves aware of the Energy Assistance
Program and become an applicant household by initiating a request to apply. All households
must be given an opportunity to apply for the Energy Assistance Program if they so desire,
whether or not applicants have all the necessary information with them at the time of
application. All information requested on the application applies to the status of the applicant
on the day of the application. If an employee of the Local Administering Agency applies for
the Energy Assistance Program, the employee must not enter their own application and the
LAA must keep the application in a separate secure location accessible only to the Director or
their designee. In addition, the application must be signed by the Director, or their designee
under the payment authorization signature line.
The Energy Assistance Program has two options available for LAAs to facilitate the client
application process. The first is the LIHEAP/IHWAP paper application that must be entered
into the LIHEAP.net system within three days of application date. The second option is
entering the application into LIHEAP.net, on-site at the time of application. The Department
is encouraging agencies to modernize to an on-site automated intake system.
WITHIN THREE DAYS OF APPLICATION DATE, ALL
APPLICATIONS MUST BE ENTERED INTO LIHEAP.net
When completing the paper application, all responses must be printed clearly and legibly. A
dark-colored ballpoint pen should be usednot a pencil or felt-tipped pen. DO NOT USE
CORRECTION FLUID TO MAKE CORRECTIONS. To correct, draw a horizontal line
through the mistake and write the correction to the side of the line.
NOTE: The Voluntary Release of Client Information form (see Section VI Exhibits) is
optional. Agencies may use this form to provide clarity for those clients or energy suppliers
who may question the certification statement on the Energy Assistance Program application
form.
VI.2
1. Single Tracking and Reporting System (STARS)
It is still the LAA’s discretionAs of November 9, 2011, OEA does not require LAAs
to enter non-PIPP (i.e. disconnected or non-PIPP participating utility) households into
STARS. It is the LAAs decision whether to put all Energy Assistance applicants into
the STARS Intake system or to input only PIPP clients into STARS. The STARS Intake
Application is provided in the Section V Exhibits as an example for those LAAs
choosing to enter all clients into STARS. At a minimum, the following information must
be completed for LIHEAP clients on the DCEO Eligibility-Intake system, STARS:
Intake Worker – Full name or User ID of Intake Worker
Family Type - Enter Single, Single Parent, 2 Adults No Children, 2 Parent Family, or
More Adults with Children, Foster Parents, 3 or More Adults No Children, Non Parent
Adult(s) with Children, or Other
Housing Type Enter Own, Rent, or Subsidized Rent
Address, City, Apt. # (if applicable), State, & Zip Enter appropriate information for
Energy Assistance Program household
Head of Family First Name, Last Name, SSN, Date of Birth, Gender, Phone Number,
Primary Language
Race – Check All That Apply
“Are you…- Check All That Apply
Income Sources - Add appropriate Income Source including, but not limited to:
AABD, Alimony, Child Support, Employment, GA, Interest, Other Wages, Pension,
SSA, SSDI, SSI, TANF, Unemployment, VA Benefits, or Worker’s Comp
Family Member #2 - ? - Add personal data for any other household/family member(s)
as appropriate. The Energy Assistance Program counts ALL persons living in a
residence.
Other? Add other information if/when applicable.
2. A. Percentage of Income Payment Plan or PIPP Application (Not applicable for the
2016 program year) - Add PIPP application information here with client choice. If
client is not PIPP eligible, or if the client chooses traditional LIHEAP, see 2. B.
LIHEAP” below.
B. LIHEAP/IHWAP Application - The following instructions have headings to correspond
with the sections on the LIHEAP/IHWAP application:
VI.3
AppID# - When this application has been entered into the LIHEAP.net system, the Application
ID # should be entered here.
Agency - Enter the Agency Name.
Intake Site - Enter the location of the intake site. If you wish, you may also use an intake site #
or code. The agency may use its own number or letter code.
County – Enter the County that the Household resides in.
PY Enter the current program year.
Application Date - Enter the date the application is taken. This will be a six-digit number. The
first two digits represent the month (e.g., January will be 01; February will be 02, etc.). The
second two digits will represent the day of the month (01/31). The final two digits represent the
current calendar year. Example: September 18, 2009, will be recorded as 09/18/09.
Service Requested Enter LIHEAP or IHWAP. If the applicant wants to apply for both
programs, enter LIHEAP/IHWAP.
Job # - When this application has been entered into the WeatherWorks system, and approved, the
Job # should be entered here.
Household Member Grid This area should contain all of the information for all household
members. If there are more than four members in the household, use an additional application or
supplemental sheet to record the additional household information.
HOHPlace a check mark on the line that represents the Head of Household (HOH).
Social Security Number - Enter each household member’s Social Security number. Hard
copy proof of SSN may include a copy of the Social Security card or any other form of
government-issued identification that shows both name and number.
Last Name/First Name/Middle Initial - Enter the legal name of the household member.
Gender - To indicate the gender of the head of household, enter M if a male; F if a female.
Date of Birth - Enter the birth date of the household member. This must be entered in the
following format: MM/DD/YYYY.
Ethnic Group - Indicate the ethnic group of the household member:
1 Asian, Asian-American, Indochinese, Vietnamese
2 African-American
3 Hispanic
4 Native American
5 White
6 Other than the above ethnic groups
EmancipatedPlace a check mark on this line if the household member is emancipated.
VI.4
Disabled - Place a check mark on this line if the household member is disabled. (See
Section I for definition of Disabled.)
Veteran - This indicator has been added to the “Household Informationscreen to start
capturing the Yes or No and is now part of the application process to inquire if an
applicant is a Veteran or not.
Household Income - This section pertains to all gross income received by the household
members at the time of application. LIHEAP.net will use a 30-day income eligibility
period (starting with the date of application). Weatherization (IHWAP) uses a 12-month
eligibility period, or an approved Energy Assistance Program (LIHEAP or PIPP)
application. NOTE: After adding all exact figures for calculating household income, the
cents should be dropped. For example, $480 would be used as the income when four
paychecks are $120.15 each ($120.15 + 120.15 + 120.15 + 120.15 = $480.60 = drop the
cents = $480.00). The gross income amount should be listed in whole dollar amounts
only—always drop the cents figure. The gross income for all other members of this
household must be listed on the LIHEAP/IHWAP application and/or entered separately
into the LIHEAP.net system. For Weatherization purposes, if the household can be
documented as receiving Energy Assistance Program benefits within the past 12 months,
enter the income amount by taking the 30-day Energy Assistance Program income and
multiplying by 12. Attach a copy of the approval notification letter or a copy of the
LIHEAP.net screen.
For IHWAP, documentation must be based on at least three months income prior to the
date of the application (starting with the application date). For example, the previous
year’s tax return may not be acceptable, unless it was filed near the time that the IHWAP
application was completed. If an applicant does not have proof of income for the full three
months, the best and quickest way to handle this is to have the applicant go to the source of
the income(s) and have the source complete an Income Statement.
Wages/Salaries/Self-Employment - Enter the 30-day (IHWAP-12 month) gross total of
all money, wages, and salaries (before any deductionsexcluding food or rent in lieu of
wages). Wages earned by baby-sitting and other odd jobs should also be entered on this
line.
Applicants who are self-employed must complete the Self-Employed Income Worksheet.
Wages/cash draws paid to the applicant and/or household members are considered income. The
sum on the Self-Employed Income Worksheet will be entered on the application. In addition, if
Line C of the form shows a profit and Line D is marked Yes, add the profit amount to the income
for that household member on the application. If Line C shows a loss, no action is required.
Social Security Administration (SSA) - When using the award letter as documentation, subtract
the monthly Medicare amount from the gross monthly amount to get the 30-day income. All
parts of Medicare are deducted. Medical insurance and prescription deductions shouldn’t be
counted as income. When using a copy of the check, a bank statement or a statement from the
business that cashed the check, use the actual amount to calculate the 30-day amount, or multiply
by 12 for IHWAP. Do not add Medicare amounts to this figure. Be careful not to confuse these
letters with those of Supplemental Security Income (SSI). Some monthly amounts may change.
VI.5
Unemployment - Enter the previous 30-day/12-month total of payments for unemployment.
Supplemental Security Income (SSI) - Enter the total of payments from SSI.
Temporary Assistance for Needy Families (TANF) - Enter the total of payments from TANF.
Aid to Aged, Blind, and Disabled (AABD) - Enter the total of payments from AABD.
General Assistance - Enter the total of cash or vouchers for cash from Transitional Assistance.
Other - Enter the total of all other sources of income not listed above. All Medicare
deductions should not be counted as income for Social Security Exempt Pension
Programs (for example: Rail Road Retirement, Teachers Retirement, etc.).
Total Household Income - Add items and enter total.
NOTE: The LIHEAP.net system is programmed to compare total household income and
number of people in the household to the Federal Poverty Guidelines published in the US
Department of Health and Human Services Federal Register. There can possibly be a
very slight rounding difference when the Income Guidelines are compared to the
rounding used by LIHEAP.net. In past program years a household of five with income
exactly matching the published Income Guidelines for the program year was LAA
Denied for Over Income. For the 2012 (or after) Energy Assistance Program, if a LAA
has such a situation where the LIHEAP.net system denies an application for Over
Income, and the 2012 (or after) Income Guidelines published in the Energy Assistance
Program Procedures Manual show the household should be income eligible, you must
consult with your Grant Manager for instructions on how to proceed with the application.
Dwelling Type - To indicate the type of a household’s dwelling circle one of the following:
Single Family dwelling unit means a structure containing no more than one household
unit.
Two to Four Units if there are two, three, or four household units in the dwelling or
building in which the applicant's household resides (e.g., a two-story house with one
apartment on each floor would be two units).
Five to Ten Units if there are five to ten household units in the dwelling or building in
which the applicant's household resides. For IHWAP, the Department approval is
required for buildings with five or more units.
Eleven or More Units if there are 11 or more household units in the dwelling or building
in which the applicant's household resides.
Mobile Home if the applicant resides in a mobile home.
Group Home if three or more people not related by blood or marriage where cooking
and eating facilities are shared or nonexistent, and which has previously been established
and identified as a group home.
VI.6
Single Room Occupancy (SRO) means a converted hotel or building whose occupants
rent a room and do not share eating facilities and are living as independents (i.e., not part
of a common group), and which has previously been identified as an SRO.
Shelter means units that house individuals principally on a temporary basis who may or
may not be related to one another and who are not living in nursing homes, prisons, or
similar institutional care facilities.
Ownership Circle the appropriate choice:
OwnsYes or No
Rent – The household pays rent.
Subsidized Housing - The household lives in subsidized housing.
Rent $ - If the household rents, enter the amount of the monthly rent payment. If the household
owns, draw a line through the space. Negative rent (Housing Authority) should be entered as 0.
Food Stamps/SNAP If anyone in the household receives Food Stamps/SNAP assistance,
then circle/check Yes.
Service/Site Address - Enter the household’s Service/Site Address, including City and Zip
Code. Try to be as detailed as possible, making note of any number/letter of the
Apartment, Box, Building, Floor, Trailer Lot and/or other identifier. This address will be
verified when the application is entered into the system.
Phone # 1 - Enter the head of household’s telephone number or a number where he/she can
be reached. Then circle the appropriate type of Phone #1 (home, cell, work, etc.).
Phone # 2 - If the telephone number is other than that of the head of household, or an
additional number has been provided, enter it here. Circle the appropriate type of Phone #1
(home, cell, work, etc.).
Mailing Address - Enter the head of household’s mailing address if different than
Service/Site Address listed above. If the Mailing Address is the same as the Service/Site
Address, mark the Same As Service Address Box (on LIHEAP.net).
Referral Check any of the listed programs that the household has been referred to.
Vendor Information:
Client Pays - Separate boxes are available to capture the Client Pays data on the
application for primary and/or secondary vendors. Mark either or both boxes if the
applicant pays the bill(s) directly to the vendor(s). Do not mark the box if the applicant
pays the bill but the account is in another’s name (e.g., the landlord’s).
VI.7
NOTE: When a household heats with/is billed for gas and also has an electric bill, from the
same utility WITH THE SAME ACCOUNT NUMBER, this is a “Dual Vendor” situation.
When using LIHEAP.net there is a Dual Vendor option and the utility information only
needs to be entered once by the LAA in this dual section. However, due to limitations of
LIHEAP.net, if a household received part of the available Reconnection Assistance benefit
with the initial application, if the household applies for Reconnection Assistance with a
subsequent application the Dual Vendor will return a LAA Denied reason of Maximum
Benefits Received. If this situation occurs, the LAA should enter the utility account
information as a Primary and Secondary vendor, then the Primary side of the application
should be left in LAA Denied, and the Secondary side of the application should be put back
in Pending status and reprocessed so the household will receive the remaining balance of
the RA funds available to that household. If you have questions about this, please contact
your Grant Manager.
Medical Certification - Mark this box if the applicant household qualifies as a Medical
Household.
Customer of Record (COR) - Print the name of the primary and secondary customers of
record.
Alternate Billing Information on LIHEAP.net:
Alternate Billing Information: This section is to be used if the information listed on the vendor
utility bill is different than the information collected in prior sections of the application. If any
information is completed in this area, all fields must be completed.
The customer of record on the utility bill(s) MUST be the name of an adult in the
application household (with rare exceptions approved by your Grant Manager).
Same As Primary Customer: Mark this box if the primary customer first and last name is the
same as the primary customer listed in the Vendor Information section. This box should only be
marked if the names are exactly the same, including spelling, and any salutations or suffixes.
Same As Secondary Customer: Mark this box if the secondary customer first and last name is
the same as the secondary customer listed in the Vendor Information section. This box should
only be marked if the names are exactly the same, including spelling and any salutations or
suffixes.
First Name/Last Name: Print the first and last name of the primary and secondary
customer if different from the Head of Household name. This field is primarily used if the
customer name on the utility bill is spelled differently from the customer’s name as it
appears on social security card or other identification received from the client, and entered
in prior sections of the application. It is critical for system verification that the client’s
name appears exactly as it appears on the utility bill.
VI.8
Fuel Primary - Enter the fuel type of the primary vendor on the line. Fuel types are:
Natural Gas
Propane
Fuel Oil
Electric
Wood
Coal
Kerosene
Other (Corn)
Fuel Secondary - Enter the fuel type of the applicant’s Secondary vendor. To be heat-
related, the electricity must be an essential part of the primary heating system such as an
electric thermostat, or a heating system fan or pump.
Special Instructions on Applicants Who Cut Their Own Wood as a Primary Fuel -
Applicants who cut their own wood are not eligible for LIHEAP assistance. If, however, a
reputable vendor is available and signs a vendor agreement, a DVP can be made to the
wood vendor on the household’s behalf.
Vendor - Print the name of the primary and secondary vendor. The primary vendor is the
heat source for the unit. The secondary vendor is the electric source. The name is copied
from a current bill the applicant presents.
There are some accepted abbreviations for certain vendors:
Ameren Illinois AmIL
Commonwealth Edison ComEd
North Shore Gas North Shore
Northern Illinois Gas NICOR Gas
Peoples Gas PG
Note: The secondary heat-related vendor will always be an electric vendor.
Account Number - Enter the applicant household’s Primary and Secondary vendor
account numbers. If the vendor does not use an account number, enter the applicant’s last
name plus last four digits of the Social Security number.
Status Enter the status of the account. Is it disconnected from that vendor?
IHWAP Eligibility Section of the LIHEAP/IHWAP Paper Application:
EligibleYes or No
Eligible Due to: Income – If the household is eligible due to income, check this line.
VI.9
Eligible Due to: 66% Rule Weatherization only if 66% of the IHWAP
households residing in this Site are eligible, check this line.
Eligible Due to: 50% Rule Weatherization only if 50% of the IHWAP
households residing in this Site are eligible, check this line.
Eligible Due to: Auto - Weatherization only if any household member receives
SSI, or TANF, or AABD, check this line.
Eligible Due to: Energy Assistance Program Weatherization only if the
household is eligible for Energy Assistance Program, check this line.
Eligible Due to: HTF Weatherization only if the household is eligible for the
ECHR (Energy Conservation Home Repair) program and the Housing Trust Fund,
check this line.
Prior Weatherization Assistance if the household was previously weatherized,
then enter the date here.
Energy Assistance Program Furnace Date if the household received prior
Furnace Assistance, then enter the date here.
Re-Determination IHWAP if more than 12 months have passed since the last
IHWAP application was approved: then enter the re-determination here.
Documentation - Enter the status of the needed documentation and the date here.
SUPPLEMENTAL
QUESTIONS