Forms and Funding Applications

April 25, 2012

Audience:: Low Income Home Energy Assistance Program (LIHEAP)
Topics:: Guidance, Policies, and Procedures
Types:: Forms

Form	Due Date	Submit To:	Instructions	AT or IM
Detailed Model Plan DOC 110KB	September 1	LIHEAPsubmissions@acf.hhs.gov	Application Reminders Schedule for Detailed Plans	IM on Model Plans
Abbreviated Model Plan DOC 56KB and	September 1	LIHEAPsubmissions@acf.hhs.gov
Program Integrity Assessment Supplement DOC 81KB	September 1	LIHEAPsubmissions@acf.hhs.gov
Household Report – Long Form XLS 25KB	September 1	LIHEAPsubmissions@acf.hhs.gov	DOC 218KB	AT on Household Report Submission
Household Report – Short Form XLS 20KB	September 1	LIHEAPsubmissions@acf.hhs.gov	DOC 218KB	AT on Household Report Submission
Leveraging Report Form DOC 67KB	November 30	LIHEAPsubmissions@acf.hhs.gov	DOC 63KB	AT on Submission of Leveraging Reports
Carryover and Reallotment Report - DOC 28KB	August 1	LIHEAPsubmissions@acf.hhs.gov	DOC 28KB	AT - DOC 28KB
Quarterly Obligation Estimates--Form ACF-535 XLS 21KB	September 1	Lydia.peele@acf.hhs.gov		LIHEAP Action Transmittal
REACH Model Plan DOC 79KB)	March 31	LIHEAPsubmissions@acf.hhs.gov		AT on REACH
LIHEAP Grantee Survey Form XLS 58KB	December 15	Leon.litow@acf.hhs.gov	DOC 92KB	AT on Grantee Survey
Standard Form 425 PDF 108KB		Lydia.peele@acf.hhs.gov or OLDC	General Instructions for completing the SF 425 Request OLDC Access - Form and Instructions	LIHEAP Action Transmittal