20040624Responses of Avista to CAPAI Part I.pdf

Avista Corp.
1411 East Mission PO Box 3727
Spokane, Washington 99220-3727
Telephone [phone]
Toll Free 800-727-9170
HECEIVED 0fLED
zno~ JUri 23 At1 9: 26
'iI'STAe
Corp.
June 22, 2004
.. !L r;G j-UBLiC
UTiLiTIES COr1HlSSlON
Brad Purdy
Attorney at Law
2019 N. 17th St.
Boise, ill 83702
Re:First Production Request of CAP AI.
in Case Nos. A VU-04-0 1 and A VU-04-0 1
Mr. Purdy,
I have attached one copy of Avista s response to CAP AI's Data Request No(s).!, 2, 3
, 15, 18, 19 29,, and 41.
If you have any questions, please call me at [phone] or Don Falkner at (509) 495-
4326.
Mike Fink
Rate Analyst
A vista Utilities
Enclosures
Cc:M. Karp
S. Woodbury
D. Peseau
A. Yanke!
C. Ward
(A W.I.S.
(IPUC)
(Utility Resources, Inc.
) -
(Yankel & Assoc, Inc.
(Potlatch)
VISTA CORPORATION
RESPONSE TO REQUEST FOR INFORMATION
JURISDICTION:
CASE NO:
REQUESTER:
TYPE:
REQUEST NO.
Idaho
A VU - E-04-0 1 / A VU -04-0 1
CAP AI
Data Request
DATE PREPARED:
WITNES S
. RESPONDER:
DEPARTMENT:
TELEPHONE:
06/21/2004
Don KopczYnski
J on Powell
Utility Strategies
[phone]
REQUEST:
With respect to the Company s Low Income Weatherization Assistance Program ("LIW A"
please provide the following information:
a. history of funding;
b. number of units weatherized;c. description ofLIW A program design, from 1984 to present;d. identify and provide any cost-benefit analysis used to assess LIW A, and;e. the percentage of Company gross operating revenues that were spent on LIW A each year
as well as shareholder and/or ratepayer funds spent each year in dollars, from beginning
of LIW A program to present, including corresponding number of customers served.
RESPONSE:
1 a. Funding for the limited income weatherization program has been derived from the
Company s Demand-Side Management (DSM) funds. Since 1995, DSM has been funded
through a "tariff rider" mechanism (a surcharge on retail rates). The tariff rider is
incorporated into the Company s Schedule 91 (Electric) and 191 (Gas) tariffs. During the
1997 to 2000 time period the gas DSM tariff rider was set at 0%, thus yielding no revenue for
funding gas-efficiency proj ects.
b. The Company s limited income programs include weatherization and non-weatherization
measures. For a significant portion of this history the community action agencies
implementing the limited income energy-efficiency program under contract to A vista have
not been required to track customers by measure. The table below represents the total
number Idaho limited-income customers served with DSM-funded energy-efficiency services
of all measures.
Number of Limited Number of Limited
Year Income customers Year Income customers
1989 1997
1990 1998
1991 1999
1992 2000 116
1993 2001 109
1994 2002
1995 2003
1996
Response to CAPAI Request No.
Page 2
lc. For the majority of the history of the Company s limited income program Avista has relied
upon community action agencies (CAA's) to carry programs into the field. This approach
leverages the infrastructure that the CAA' s have created to implement a broad variety of
energy and non-energy programs for the limited income community to include field services
outreach and income qualification.
In 1988 , both Avista Utilities and the CAA's adopted the U.S. Department of Energy (DOE)
standards for weatherization programs. Measures incorporated within the weatherization
program include shell insulation (ceiling, wall and floor insulation and ventilation),
replacement of compromised windows, air leakage control and duct testing and sealing.
Recently new procedures related to lead paint identification and abatement were added to the
program.
The Company s agreement with the CAA's permit up to 15% of health and human safety
measures to be included with energy-efficiency improvements. These measures enhance the
long-term habitability of the structure and increase the life of the energy measures
themselves.
The CAA' s receive a reimbursement for administrative costs incurred on behalf of the
energy-efficiency programs equal to 15% of the cost of all installed measures.
Id. Avista completes periodic reports on energy-efficiency program activity for the External
Energy Efficiency ("Trip le- E") board. These reports include a detailed breakout of the
limited income program and an assessment of cost-effectiveness of various components of
the demand-side management portfolio. The Triple- E reports, as well as additional summary
data covering the period of time prior to the formation of the Triple-E board, are attached as
part of the response to Data Request #8.
1 e. The following table represents limited income weatherization expenditures, number of
customers served, total Company gross operating revenues and the percentage of gross
operating revenues expended on limited income weatherization. These calculations have
been broken out into separate gas and electric tables. Reimbursements of administrative
expenses to the community action agency are not included.
(co!. 1)
Year
1999
2000
2001
2002
2003
Electric Weatherization Pro2ram(co!. 2) (co!. 3) (co!. 4)Wx $ # customers Electric Gross Op Rev
$18 824 13 $184,411 862
$30 126 23 - $240 941 821
$36 860 22 $176 310 592
$39 990 17 $161 262 822179 8 $177 232 917
(co!. 5)
%Wx
010%
013%
021010
025%
003%
Note: In 2003 electric DSM funds were augmented with funding from BPA'
Conservation and Renewable Discount (C&RD) program. Many electric
weatherization proj ects acquired in that year were funded through the BP A
program and are not included in these calculations.
Response to CAPAI Request No.
Page 3
(col. 1)
Year
2001
2002
2003
(col. 2)
Wx$
$56 270
225
$30 735
Gas Weatherization Pro2ram(col. 3) (col. 4)
# customers Gross Op Rev12 $57 989 0612 $60 190 58338 $52 328,420
(col. 5)
%Wx
097%
005%
059%
Column 1: Calendar year.
Column 2: Actual limited income weatherization expenditures within Idaho only and for
the appropriate fuel (gas or electric). This amount does not include
reimbursement of administrative costs to the community action agency, nor
does it include non-weatherization measures.
Column 3: Number of customers served with the expenditures in column 2.
Column 4: Gross operating revenue for the appropriate fuel. Collected from FERC forms
1 and 2, State Supplements, Page 300, line 27.
Column 5: The weatherization expenditures in column 2 divided by the gross operating
revenues in column 5.
It should be noted that the Company s limited income program is not limited to
weatherization measures.
VISTA CORPORATION
RESPONSE TO REQUEST FOR INFORMATION
JURISDICTION:
CASE NO:
REQUESTER:
TYPE:
REQUEST NO.
Idaho
A VU-04-01 / A VU-04-
CAP AI
Data Request
DATE PREPARED:
WITNESS:
RESPOND ER:
DEP ARTMENT:
TELEPHONE:
06/21/2004
Don KopczYnski
J on Powell
Utility Strategies
[phone]
REQUEST:
Please provide corresponding data on types of allowable measures (e., attic insulation, pipe
wrap, water heater wrap, etc.) and dollars spent by type of unit (single family, multi-family,
mobile home) for LIW A.
RESPONSE:
The Company does not track weatherization expenditures or customers by individual types of
weatherization measure or type of residential unit.
All weatherization measures permitted under U.S. Department of Energy standards are allowable
within the A vista program. The majority of customers receiving assistance through the limited
income weatherization program access multiple types of weatherization assistance as well as
non-weatherization assistance.
VISTA CORPORATION
RESPONSE TO REQUEST FOR INFORMATION
JURISDICTION:
CASE NO:
REQUESTER:
TYPE:
REQUEST NO.
Idaho
A VU-04-01 / A VU-04-
CAP AI
Data Request
ATE PREPARED:
WITNESS:
. RESPONDER:
DEPARTMENT:
TELEPHONE:
06/21/2004
Don KopczYnski
Jon Powell
Utility Strategies
[phone]
REQUEST:
Please provide a history of funding and description of program design, from 1984 to present, for
the following:
a. low-income rate discounts offered by the Company;
b. low-income energy efficiency programs;
c. low-income fuel funds (i.e., voluntary contributions by A VISTA shareholders and/or
ratepayers for energy assistance);
d. any other low-income energy programs, and;
e. any special rates for other A VISTA residential, commercial, or industrial customers.
RESPONSE:
3a. Avista does not currently offer low-income rate discounts.
3b. Prior to 1995 the Company funded electric-efficiency programs (including limited income
programs) through the traditional approach of ratebasing expenses for future recovery.
1995 the Company instituted a demand-side management (DSM) tariff rider, in the form of
Schedule 91 , to fund electric-efficiency programs. Since that date electric-efficiency
programs have been funded through this tariff rider mechanism.
Gas-efficiency programs were originally funded with gas overcharge funds. Upon the
expiration of these funds the Company funded gas DSM through a tariff rider mechanism
similar to that established for electric DSM. The gas tariff rider, Schedule 191 , was initiated
in 1995 and funded gas DSM programs during 1995 and 1996. Due to falling gas avoided
costs the tariff rider was taken down to a 0% level during the 1997 to 2000 time period.
2001 the Schedule 191 tariff rider was increased to its current level with the funding again
being applied towards gas-efficiency measures.
Since 1999 limited income programs have been fielded by local community action agencies
(CAA's) operating under contract to the Company. Prior to that date limited income
programs were implemented with a mixture of utility-implemented programs and cooperative
programs with the CAA's. At present the Company contracts with five CAA's for delivery
of limited income programs throughout the Washington and Idaho service territory. One of
these CAA', the Lewiston Community Action Partnership, serves the entire Avista service
territory within Idaho.
Contracts with the CAA' s are limited to one year in duration. The Company has
progressively increased the degree of flexibility of these contracts to enable the CAA to
leverage other programs offered to the limited income community to the maximum extent
Response to CAPAI Request No.
Page 2
possible. This flexibility includes the ability to use contractual funds for electric or gas-
efficiency measures (subject to a maximum of 50% of total funding for gas-efficiency) and
complete control over measures targeted and implemented. The Company does intervene
late in each year to reallocate funds from those agencies that are unable to use their full
contracted amount to those CAA's that have customer demands in excess of their funding.
most years CAA' s have been permitted some form of carryover of unused funds to the
subsequent calendar year.
Contracts with the CAA's include a provision allowing for up to 15% of funding to be used
for health and human safety measures intended to enhance the habitability of the home and
increase the longevity of the installed energy-efficiency measures. These measures are
typically related to shell integrity (e.g. repairs of leaking roofs), electrical wiring safety and
recently, lead paint identification and abatement.
The CAA's are also reimbursed for their administrative costs, to include outreach, income
qualification and administrative expenses, up to 15% of the total cost of each installed
measure.
The aforementioned contracts with CAA's were augmented with additional funding through
the Bonneville Power Administrations Conservation and Renewable Discount program. The
funding and resource acquisition of this program are tracked separately from DSM program
achievements. However, availability of these funds have influenced the distribution ofDSM
funds by establishing an alternate source of funding for many electric measures.
The electric and gas-efficiency measures allowable under the contract are extremely broad.
Weatherization measures of all types, duct testing and sealing, infiltration, replacement of
compromised windows, duct testing and sealing, furnace and water heating appliance
efficiencies, conversion of electric appliances to natural gas and efficient air conditioning
(for customers with a medical need for space cooling) are all permissible under the contract.
3c. Project SHARE is a fuel-blind community funded program. Avista is one of several energy
providers that participate in the collection of contributions. A vista customers are not the only
recipients of Project SHARE funds. The fund is administered in cooperation with a
community action agency. The community action agency does not report numbers of
customers served by utility or jurisdiction to Avista, making the calculation of average
expenditure on behalf of the customer impossible. The table below represents total A vista
system expenditures.
Proiect SHARE
Year A vista expenditure
1996 $366 055
1997 $366 762
1998 $366 200
1999 $344 811
2000 $330 811
2001 $412 865
2002 $538 521
2003 $530 661
Response to CAPAI Request No.
Page 3
3d. The Company s limited-income program is composed of energy-efficiency assistance and
Project SHARE exclusively, as described in sections 3b and 3c of this response respectively.
3e. Avista has special negotiated rates with 14 large gas transportation customers - 6 in Oregon
5 in Washington and 3 in Idaho. All of these customers are located in close proximity to a
natural gas pipeline and had the ability to bypass the A vista s distribution system. The
negotiated distribution / transportation rates for each of these customers was based on their
estimated cost of bypass. Avista has no other "special" (negotiated, non-tariffed or
otherwise) retail rates with any other electric or gas customers.
VISTA CORPORATION
RESPONSE TO REQUEST FOR INFORMATION
JURISDICTION:
CASE NO:
REQUESTER:
TYPE:
REQUEST NO.
Idaho
A VU - E-04-0 1 / A VU -04-0 1
CAP AI
Data Request
DATE PREPARED:
WITNESS:
RESPONDER:
DEP ARTMENT:
TELEPHONE:
06/21/2004
Don KopczYnski
J on Powell
Utility Strategies
[phone]
REQUEST:
With respect to the preceding Request, please include number of customers served each year and
average amount paid on their behalf, as well as the total amount of A VISTA gross operating
revenue spent on each program per year from 1984 to present.
In responding to this Request, please include a break-out of fuel type, income and age
renter/owner ratios, or other demographics about these residential customers. Include any
internal analysis, studies, memos, etc., relevant to these customers.
RESPONSE:
The Company does not offer rate discounts, special rates or any programs geared towards limited
income customers other than electric energy-efficiency, gas energy-efficiency and Project Share.
The expenditure, number of customers and average amount per customer for the energy-
efficiency programs are represented in the table below.
Limited Income Energy-Efficiency Programs (gas and electric)
Year LI DSM expenditure # customers Average per customer1989 $66 583 74 $9001990 $68 584 57 $1 2031991 $61 919 82 $7551992 $81 652 67 $1 2191993 $112 000 79 $1 4181994 $111 000 69 $1 6091995 $71 739 65 $1 1041996 $50 824 34 $1,4951997 $42 792 24 $1 7831998 $64 027 44 $1 4551999 $190 883 82 $2 3282000 $270 537 116 $2 3322001 $280 957 109 $2 5782002 $152 085 50 $3 0422003 $107 076 81 $1 322
The energy-efficiency expenditures are based upon the actual expenditures for all measures
offered within the limited income program portfolio. Limited income customers accessing the
residential portfolio are not included in the table above. The expenditures above represent the
Response to CAPAI Request No.
Page 2
cost of field services only and do not include reimbursement of community action agency fees or
any component of utility administrative or marketing support.
Actual expenditures may not equal contractual funding in any specific year due to the
Company s authorization of roll-over funds to subsequent year and reallocations of funding
among community action agencies to maximize overall funding availability.
Project SHARE is a fuel-blind community funded program. Avista is one of several energy
providers that participate in the collection of contributions. A vista customers are not the only
recipients of Project SHARE funds. The fund is administered in cooperation with a community
action agency. The community action agency does not report numbers of customers served by
utility or jurisdiction to A vista, making the calculation of average expenditure on behalf of the
customer impossible. The table below represents total A vista system expenditures.
Proiect SHARE
Year A vista expenditure
1996 $366 055
1997 $366 762
1998 $366 200
1999 $344 811
2000 $330 811
2001 $412 865
2002 $538 521
2003 $530 661
The Company does not collect demographic information of customers receiving service under
the limited income program. Nor has the Company completed any analysis specific to our
limited income customer segment receiving service under our energy-efficiency programs.
VISTA CORPORATION
RESPONSE TO REQUEST FOR INFORMATION
JURISDICTION:
CASE NO:
REQUESTER:
TYPE:
REQUEST NO.
Idaho
A VU-04-01 / A VU-04-
CAP AI
Data Request
DATE PREPARED:
WITNESS:
. RESPONDER:
DEP ARTMENT:
TELEPHONE:
06/21/2004
Don KopczYnski
Jon Powell
Utility Strategies
[phone]
REQUEST:
In the event the Company utilizes criteria to define "low-income" other than 150% of poverty
level under the federal guidelines, please identify all criteria used by the Company to categorize
customers as "low-income" customers. In doing so, separately describe each specific company
procedure in which these criteria are used to identify and categorize low income customers.
Please provide a copy of each such procedure, including a copy of any staff training or
operations manual in which the procedure is set forth or otherwise discussed.
RESPONSE:
The Company complies with the 150% of poverty federal guideline. Please refer
to the attached document "State Income Guidelines" for the Company s criteria for income
qualification guidelines.
DATE: December 1997 PAGElof4
CAN CELS:REFERENCED IN: 10 CFR440.22(a)
. CTED Energy Assistance Program Policies
CHAPTER 2: INCOME ELIGffiILITY STANDARDS
SECTION 2.TYPES OF INCOME CO~TED
PolicY
When earned income is being considered, all pay periods must be
accounted for in the period used to establish eligibility.
Only income reported by current members of the household should be
considered.
F or purposes of detennining household eligibility, contractors are required
to o~tain written documentation for eac~ of the prior three months for
income received through the following:
Refugee Assistance Program (RAP)
Aid to Families and Dependent Children (AFDC)
General Assistance (GA)
Supplemental Security Income (SSI)
Other Department of Social and Health Services
(DSHS) assistance programs
Social SecUrity Administration (SSA) benefits
The documentation received from DSHS and the SSA regarding income
received by an -applicant for the month prior to application will be
considered the average monthly income from the income source -- unless
the applicant indicates the income varied in amount over the period
considered.
s:\biplaollWl \1ihc:ap \PP-RE V97
DATE: December 1997
CAN CELS:
PAGE 3 of 4
REFERENCED IN: 10 CFR 440.22(a)
CTED Energy Assistance Program Policies
If none of the income is from salaries or wages, the 20 percent
cannot be taken. Th~ average is detennined by dividing the
unadjusted total, $3 023., by the number of months considered
three. The average is $1 007.66. Refer to Exhibit 1.2 A, Income
Eligibility Guidelines, to determine if the household income is at
or below the per month amount required to qualify.
Deduction Applied to Retirement Income
Deduct ten percent from all taxable retirement income at the time
of payout, such as Social Security and other types of retirement
. -
and pension plans. (See Exhibit 2., item 6.
Deduction for Child and Spouse Support Payments
Deduct payments for child support and spouse maintenance.
Consider only the income of current members of the household
Example:
A woman applies for the program on January 22 and lists the
names of herself and her two children on the Household Member
and Income Information F onn. She reports a household of ~ee.
She also reports that her husband left on January 2 (and is
presumably not coming back). Her husband earned $500 during
December, but because he is no longer a member of the household
his income is not to be considered in determining eligibility.
Types of Income: Exclusions and Deductions
Refer to Types of Income, Exhibit 2.
))~~
August 1997
CANCELS:
EXHIBIT 2.
PAGE 1 OF'
DEFINING TYPES OF INCOME, EXCLUSIONS, AND DEDUCTIONS
All money, wages, and salaries including any garnishment.
A 20 percent deduction will be made for wages and salaries
taxed at time of payout.
. a.Earned or self-employment income received by a
household member who is 18 years or younger and is
a student (at least half-time as defined by the
institution) at a kindergarten or preschool, a grade
school, high school, vocational school, technical
school, training program, college or university.
This exclusion shall apply to a student under the
parental control of another household member. If the
child's earnings or amount of work performed cann
be differentiated from that of other household
members, the total earnings shall be prorated equally
~ong the working members and the child's proratashare excludecL
Benefits rec~ived through programs under the Job
Training and Partnership Act (JTP A).
Earnings from the Community Services Employment
Program authorized under Title V of the Older
Americans Act of 1987.
Net profit from self-employed enterprises: business, farm,
or profession.
DATE: -Auol.Jst 1997
CANCELS:
EXHIB IT 2.
Page 3 oC'
An annuity, pension, retirement, Social Security,
Supplemental Security Income, veteran s or disa~ility benefit;
workmen s or unemployment compensation; old-age or
survivor's benefits; strike benefits; representative payee
payments paid to the beneficiary.
To calculate social security benefits, subtract the actual
Medicare premium from the benefit amount
A ten percent deduction will be made for all retirement
benefits taxed at time of payout
The total payment to a household on behalf of a legally
assigned foster child or adult
Regular or recurring (more than once) support, paid dire~y
to the household, from an absent family member, or someone
not living in the household, including cash gifts, child support,
- spouse maintenance, alimony, and refugee sponsor support
Any allocation, maintenance and support sent to the
household from absent military personnel. NOTE: The 20%
earned income deduction should not be taken.
Child support payments received by AFDC recipients which
must be transferred to DSHS Support Enforcement.
10.Estates, trusts, dividends, interests, royalties, and all other
direct cash paym~nts which are a gain or benefit (consi~ered
income for the month in which it was received).
DA~ August 1997
CANCELS:
- 8.
EXHIBIT 2.
P~ge 5 of
Reimbursements for past, or advances for 'future expenses,
not to exceed the actual or intended expense or which do not
represent a gain or benefit to the household.
Reimbursements for normal living expenses, such as rent
mortgage, personal clothing, or food eaten at home, would be
a gain to the household.
Any payments made to a third party on behalf of a household
for a household expense.
Cash received and used for the care and maintenance of a
third party beneficiary who is not a household member.
the non-household member's portion (!Bnnot be readily
identified, the payment shall be evenly prorated among
intended beneficiaries, and the exclusion applied to the
non-household members prorata share.
Actual payments from payor's gross income for verifiable,
medically required attendant care of a household member.
Common examples are Community Options Program Entry
System (COPES), Chore Semces, and Medicaid Personal
Care payments.
Federal major disaster and emergency assistance provided to
, individuals and families under Public Law 93-288, The
Robert T. Stafford Disaster Relief and Emergency Assistance
Act. This includes the Individual and Family Grant
Program (IFG), Temporary Hous~g Assistance and Disaster
Unemployment ~sistance (DUA).
DATE: December 1997 PAGE 1 of7
CANCELS:REFE-RENCED IN: 10 CFR 440.16(a)
APPLICANT FILE _AND VERIFICATIONSECTION 2.
Policy
Verification is of tWo types: required documentation and written
self-declaration. Required documentation consists of either clear
copies of the document or a signed and dated statement by the
contractor that the document was seen. Income may be self-
declared when documentation is unavailable.
F or households applying to both the Energy Assistance and
Weatherization Programs, contractors must follow the procedures
derIDed by the Energy Assistance Program.
F or households applying only for Weatherization, CTED
encourages contractors to use the Income and Residence
Verification Form shQWIl in Exhibit 2.2 C to record the "I saw
verification of applicant status, income, and residence.
The applicant file must contain:
Application Form (Exhibit 2.2 A)
Household Member and Income Information Form (Exhibit
2 B)
Income and Residence Verification Form (Exhibit
2 C) or a Declaration of No Income (Exhibit 2.2 D)
- Records showing work completed and cost of measure with
total for all measures
Property Owner-Agency Agreement (Exhibit 1.5 A)
Building Check and Job Order Sheet (Exhibit 5.1 A) or approved
equivalent Home Energy Audit F OrIn.
s: \hip \aollWl\lihcap \PP. REV97
DATE: December 1997
CANCELS:
PAGE 3 of7
REFERENCED IN: 10 CFR 440.16(a)
b. V erificationFrom Other Sources:
Employer s wage records
F ODD for release of infonnation
Statement from applicant's employer
Occupation tax agency
Local wage tax agency
State income tax bureau
Social Security Benefits (disregard Medicare payments)
. V erific~tion infonnation generally available from the
applicant:
Social Security benefit payment check
SSAISSI award letter (for pertinent period)
Correspondence from S SA on benefits (for pertinentperiod)
Fonn SSA 1099--Social Security Benefit
Statement
Verification-infonnation from other sources:
Social Security Administration
F or applicants who receive Social Security benefits
SSA or SSI--regardless of whether they receive
DSHS benefits, verify income by completing the
computer card Fonn SSA-491TC (Third Party
Query Card).
Mail the TPQY card to:
Social Security Administration
Auburn Teleservice Center
2801 "C" Street Southwest, #35
Auburn, Washington 98001
s: \!Up \go OWl \lih cap IPP - RE V97
DATE: December 1997
CAN CELS:
Other Sources
PAGE 5 of7
REFERENCED~: 10 CFR440.16(a)
N~e of person receiving SSAISSI. (Spell out
the last name).
Social Security number of person receiving
SSAISSI.
SSA claim number of person receiving SSA/SSI.
What month or months income verification should
be provided for.
- The Social Security Administration has asked that no
requests for income verification be made to local Social
Security offices.
T~ calculate income to be considered from Social Security
benefits, subtract the actual Medicare premium from thebenefit amount.
Other Pensions and Benefits
Unemployment Compensation award letter or
Detennination Notice
Pension award notice
Veterans Administration award letter.
Official correspondence on benefits
Income tax record - state and federal
Railroad retirement award letter
Support Enforcement Officer
Employer s records
Union cards
Workman s Compensation records
Veterans Administration
Lawyer s records
Insurance company records
Lodge, club or fraternal organization records
Personal or Income Tax records
Railroad Retirement Board records
United Mine Workers (Black Lung Benefits)
s: \hip \croman \I ihcap \PP - RE V97
DATE: December 1997
CANCELS:
PAGE 7 of7
- REFERENCED IN: 10 CFR 440.16(a)
For those who are unable to write, a dictated statement
written by contractor staffwill suffice with the ~pplicant'
signature or mark and date.
b. Other Possible Sources of Verification:
DSHS
. Employment Security
Statement from previous employer
12.Identity Verification (Social Security Number)
To serve as verification of identity, the Social Security
~umber of the applicant, and the second head of household
(if one is declared), is to be presented by the applicant.
Record these numbers on the application form.
Preferred:
- Copy of the Social Security card
Acceptable:
Copy of other documentation or
correspondence which indicates botp. the
name and Social Secuiity number
Written notification of the person s number
from the local Social Security Office.
5: lhip\cromau \Iihcap \PP -REV97
Washington State LIHEAP
Agency Primary SSN
Ccrt. Date
Section A:
Primary Applicant
Res. Address
Mail Address
City
Yes 0 No
Asian
Hisp ani c
Black
N .Am.Ind.
White
E. Asian
Other
Male
Female
L-J Target Group #1
L-J Target Group #2
EXHIBIT 2. 2A (13 p s .-
HOUSEHOLD INFORMATION FORM . Community Trade and Economic Development. 6-
0 EAP 0 Emergency EAP
Other Emergency Services
0 W AP Tribal Member
0 MSFW .Other
IF Emergent Need: Complete Box Below
R~~7~
~'~
;~~t;
File #
Secondary SSN
1-1
Last Name, First Name, Middle Initial
::, ;~~:,
:~:;;;d~t:.,::,,~
:;~'. . -'
. ~tiJt~/:
~: ~
Applicant Signature:
. Household Members
L-J 0-L-.J 60+
L-J 3-5 L-J Hndcpd
L-J 6-17 L-.J MSFW
. Phone Lived at Residence: yrs. mos.
Has anyone in your household received Energy Assistance (EAP) since October Interested in Free
from another agency or Indian Tribe anywhere in the U.? 0 Yes 0 No Weatherization?
If Yes, what was the dollar amount you received? 1.1 0 Yes 0 No
Housing Status ' Housing Type Heating Fuel IncomelBenefits
0 Own/Buy 0 1-3 Fam Electric 40 Oil SSI Social Security
Subsidized 2 0 4+Fam 0 Nat Gas 5 0 Wood 0 AFDC Unempl Compo
Rental .0 Hi-Rise Propane 6 Coal 0 ,GAU Earned Income
RmrtBrdr 4 0 Mobile .
. :' . . ; .'~ ~.....;.~::'--.:
- .:.~ 4 D VA Other
.'
n Temp Hsg Heat wlRent ; Rec dFoodStam s1 DVes ONo
V 01l.l11tary Data: Back Up Heat Cost. 0 Yes
Female Primary
Wage Earner?
0 Yes 0 No
Secondary Last Name, First Name
Residence City
Residence ZIP
ZIP
Household'
Monthly Income
People ,in Hsehld: Total Energy Use $0 No Heat Subsidy $
Utility Allowance $AnnUal Heat Cost $
Energy Assistance Program P.o. #
Household Eligibility Amount
Direct Pay to Applicant...
Section B:
S taff
Payment to V endor( s)
# 1 Acc#t
# 2:Acc
1.1
1.1
f--:.
Total Paid to Date
Unclaimed Balance
Other Emergency ServicesSection C:
S taft"
Heat System RepairslRep lacement
Other Repairs/Services
Total Services Provided
- P.o. #
1.1- Vendor#
; Vendor #
I certify that I have provided and reviewed the above information which is accurate to the best of my knowledge. I understand that I may be subject
to criminal prosecution if! have. knowingly provided false information. I further understand that I may request a Fair Hearing if the provision of the
above information is not acted on to determine my eligibility within a reasonable time or if! do not receive benefits for which I feel I am eligible. I
"ive my pennission for this agency and Washington State Community, Trade and Economic Development (CTED) to request/release necessary-
lation that may result in my receiving benefits from this assistance request. I further give the above listed heating vendor(s) permission to establish
a llne of credit, and/or to release my account information to this agency or CTED for current and future data analysis and eligibility determination.
Date:
November 13, 1996
r"':
EXHIBIT 2.2A (13 pages)
Page 1 of 12
PROCEDURE 50lD
COMPLETING THE HOUSEHOLD INFORMATION FORM AND THE
UPDATEIDELETE FORM
ComoIetin2: the Household Information Form
Section A - General Information
AI.
A2.
A3.
A4.
AS.
::,;J
~t~
Agency Cod~
Enter your three digit agency number. The first digit
signifies the CUITent program year (for 1997 the first digit
will be ") and the last two digits correspond to the two
digit number preassigned to your agency.
SEE: Section 500, DOCUMENTATION AND
VERIFICATION, Exhibit 501D, AGENCY AND
COUNTY NUMBERS FOR 1997 LIBEAP
Coun~
Enter the numeric designation of the applicant's county of
residence here.
SEE: Section 500, DOCUMENTATION AND
VERIFICATION, Exhibit 5.0ID, AGENCY AND
COUNTY NUMBERS FOR 1997 LIHEAP
Certification Date
Enter the date that the corresponding client file was
certified.
Prim ciat Securi Number:
Enter the social security number of the person (primary)
applying for assistance. The last box is for the social
security number suffix (A-Z), a letter designation used with
some social security numbers.
SeconQaty Socia! Securi~
If there is a second head of household, enter that person
social security number here. The last box is for the social
security number suffix (A-Z), a letter designation used with
some social security numbers.
October 15, 1996
r:f::.'7"
:~;~
. Procedure 501B:
r;:
..~~:.
8;~.
EXHIBIT 2.2A (13 pages)
Page 3 of 12
Completing the Household InformationFonn and the UpdatelDelete Fonn
All. Residence Address
This must be the address where the household resides.
the applicant does not have an official address, a description
(Blueberry Hill, Moon River) may be substituted. _If either
the Residence ZIP code or City differ from the Mailing
Address ZIP or City (see Al2 below), enter the Residence
City and Residence ZIP in the space provided to the farrig~.
A12. Mailing Address
Enter Mailing Address only if it is different than the "Resid-
ence Address" above (All). If the Residence Address and
Mailing Address are the same, use the spaces provided on
the left to enter the complete Residence Address. In that
case, the right side of the applicant/address block need no~
be completed.
. A13.
. _
~hone Number
Self-explanatory.
A14. Lived At Residence
Enter the number of years and! or months that the applicant
has lived at his/her current residence. This infonnation must
be entered into the corresponding data entry field on the
CTED Computer System.
A15. Assi~ance Ouest..iQn
This question pertains to EAP payments received by the
applicant October I of the current LffiEAP Program
Year. If "Yes" is indicated, a dollar amount must be entered
in the space provided. If "" is indicated, leave the dollar
amount blank.
A16. Interested In Free Weatherization?
If the 'applicant indicates an interest in free weatherization
services, mark "Yes" and forward one of the HIF copies to
the weatherization unit.
October 15 , 1996
Procedure. 50 IB :
....
EXHIBIT 2.2A (13 pages)
. Page 5 of 12
Completing the Household Infonnation Fonn and the UpdatelDelete Form
A21. Heating Fuel
. Check the .one -box that describes the applicant'primary
heating source.
SPECIAL NOTE:For categorization purpo~es on the
HIF, kerosene should be marked
as "Oil" and presto logs should be
marked as "wood". Any other
categorization questions should be
directed to your assigned CTED
program manager.
A22. IncomelBenefits
Check all sources of income or benefits received by househ-
old members. If the household has no source of in-
comelbenefits, leave all the boxes blank.
SEE:. Policy 205, DEFINING TYPES OF ~COME,
EXCLUSIONS, AND DEDUCTIONS
A23 Household's Monthly Income
If the applicant has indicated income or benefits (see A22
above), enter the verified average monthly income from
those sources. If the applicant indicates no income, enter a
zero in the space provided. "When calculating average
monthly .income, round the final amount to the nearest
whole
A25. People in Household:
Enter the number of people residing in the applicant'household.
SEE: Policy 203 , DEFINING TYPES OF
HOUSEHOLDS
A26. Total Ener Use
If available enter the total amount billed for the annual
con~umption of total energy by the household in the current
residence. If a full twelve months of billing ~story is not
available surrogate billings for the residence may be used
to fill in the gaps in the total annual billing.
October 15, 1996
'-":-';;'
"~;o,
';- ,
Procedure' 50 IB:
- .",. - - - -;":;:"~:,.,
EXHIBIT 2. 2A (13 pages)
Page 7 of 12
Completing the Household Infonnation Fonn and the UpdatelDelete Fonn
A29. Hea~ Subsiqyt.
If available, enter the annual heat subsidy portion of the
annual utility allowance for households who reside. in,
subsidized housing. The annual heat subsidy will be used
by the computer in the client program benefit cal~iilation.
the heat subsidy is not available, enter the amount of the
household's annual utility allowance in the "Utility
Allowance $" field located immediately below (A30).
SPECIAL NOTE:If "Subsidized" is entered under
Housing Status, the computer
system will require that a
corresponding entry be made in
either the Heat Subsidy S or Utility
Allowance $ fields.
SEE: Procedure 702, B., Page 1 of 1 Detenninin!!: The
Heatin~ PoJiion Of The Total Monthly UtilittAllowan ce
A3 o. Utili Allowance
If ~e heat subsidy amount is not available for a household
in subsidized housing, enter the annual utility allowance in
this field. If an entry is made in this' field, the computer
system will use the entry to calculate a corresponding
annual hea~ subsidy and will enter i~ in the appropriate field
located above. The annual heat subsidy -will then be used by
the computer in the household program benefit calculation.
. .
SPECIAL NOTE: The computer system will not allow
. operators to manually enter
amounts in both the Heat Subsidy
and Utility Allowance S fields.
Section B - Energy Assistance Program
Bl.o. #
Optional. This space is for contractors use. There is a
corresponding data en~IY field on the CTED Computer
System.
B2.Staff:
Optional. This space is for contractor's use.
October 15, 1996
Procedure 5o.IB:
:~?~f:"~"
EXHIBIT 2 .( 13 pages)
Page 9 of 12
Completing the Household Information Form and the UpdateIDelete Fonn
Blo.. Payment to Vendor #2
Enter the dollar amount, if any, paid to Fuel Vendor #2
(B8). Ifnot applicable, leave blank.
B 11. Total Paid to Date
Total ofB4, B7, and Blo.. The CTED computer system
will automatic~y calculate and enter this amount. You will
not be allowed to change the amount calculated by the
CTED computer system.
B 12. Unclaimed Balance
This dollar amount must equal the difference between B3
and B 11. The CTED computer system will automatically
calculate and enter this amount. You will not be allowed to
change the amount calculated by the CTED' computer
system.
Section C .- Other Emergency Services
C1.O. #
Optional. This space is for contractor's use. There is a
corresponding data entry field on the CTED Computer
System.
C2.Staff:
Optional. This space is for contractor's use.
C3.Heat System RepairslReplacement
Enter a dollar amount up to $1 50.0. for this category. Ifnot
applicable, leave blank. The agencY s energy assistance data
base ~ust be programmed to accept a number from 140. 1
to 1499 for each heat system repair or replacement vendor.
SPECIAL NOTE:The maximum combined benefit for
all Other Emergency Services (Heat
System RepairslReplacement and
Other Repairs/Services) is $1,500.
Vendor #
On the Vendor # line immediately following "Heat System
RepairslReplacement", enter the corresponding agency-
assigned vendor number between 140. 1 and 1499.
I,,:..~
. "~:-
ri'
\;.::,
October 15, 1996
Procedure 501B:
EXHIBIT 2.2A (13 pages)
Page 11 of 12
Completing the Household Information Form and the UpdatelDelete Form
SPECIAL NOTE:Language has been added to the
certification statement, for use in
the 1996 LIHEAP year and
beyond, which-allows the
contractor agency and CTED to
request and release information
necessary for the applicant to
receive energy assistance benefits,
and .for the applicant's heating
vendor (listed on the form) to
release account information to the
agency and CTED for current and
future eligibility determination.
Date
Enter the date t~e ,HIF is signed by the client.
Comoletin2 the UodatelDelete Form
Update
The update only works if a client has already been accepted on the
computer system with a previous service. For example: John Doe
applies for EAP on December 12 and on January 15 John applies
for Other Repairs/Services. The update process will add bther
Repairs/Services to the current computer file- for John Doe, now
showing he has received both EAP and Other
Rep~s/SeIVices. Mark the boxes at the top of the F onn
UPDATE" and "OES" (Other Emergency Services).
If you nee~ to update other pieces ofinfonnation onthe HIF, such
as income, nu~ber in household, etc., complete an UpdatelDelete
Form and place in the client file.
To submit an update of type ofseIVice, complete the following
fields on the UpdatelDelete Form:
Agency number
County code
UPDATE box must be checked
Check if applicable (HIP)
Check box if applicable (EAP)
Check box if applicable (DES)
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EXlllBIT 2.
INCOME AND RESIDENCE VERIFICATION CHECKLIST
LOW-INCOME WEATHERIZATION PROGRAM
I certify that I have seen the following documentation:
SSA# or Other I.For Name
SSA# or Other I.
lliC.QME
( )( )( )( )( )- (
RESIDEMCE
For Name
Check S~b(s)/Employer Statement (Check Stub #'
. Bank Statement
Award Letter from
through
DSHS Microfiche
Social Security TPQY
Other (Describe)
, for the Period of
., in the Amount of $
( )( )( )
DeedlTitle
Tax Statement
Other (Rent Receipt, Statement, etc.) for Property Located at
Address
( )
Parcel #Rent Receip~ # and Amount
Signature of Agency Staff Date
C:\DC)C$I\CR.OMANlEXHIBIT2.2C (rev IOnl'J2)
DATE: 4/93
CANCELS:
EXHIBIT 2.2D
PAGE 1 OF 1
DECLARATION OF NO INCOME STATEMENT
do hereby declare that
NEITHER 'I. 'NOR ANY MEMBER OF MY BOUSEHOLD BAS RECEIVED ANY INCOME FOR2.
(the 3-months pr~or to the month of application)
I certify that the information contained in this No-Income Declara-
tion is complete and accurate to t~e best of my knowledge-I under-
stand that I 'am signing this No-Income Declaration under. pen~lty Qf
cr iminal pr~secution if I knowingly g1 ve false information which re-
suI ts in assistance for which I am not eligible.
My basic living needs (shelter, food, and utilities) have been met
the last three months by:
these needs have been met)
(Give a brief explanation of bow
SHELTER:
- FOOD:
UTILITIES.
WITNESSED BY:
Signature of Agency Repres~ntati Signature
. Date Signed Date Signed
. .
- DATE: 4/93
CANCELS:
EXHIBIT 2.2F
PAGE 1 OF 10
INSTRUCTIONS
THIRD P AR'IY QUERY
INSTRUCTIONS
'!'hi rd Par ty Query
encil only.To complete the card (see Page 3), use a Number 2
BLOCE- NUMBER
BLOCK NUMBER 2:
BLOCK NUMBER 3:
BLOCK NUMBER 4 :
Prefix Column -- DO NOT USE - LEAVE BLANE.
B - (HEALTH INFORMATION REQUEST)
R - Column - BLACK OUT the tiny .S. in the middle
of the column when -requesting information for
medicare premium or disability information.
Otherwise, leave blank. When left blank, only
benefit information -will be returned on theprint-out.
Social Secur i ty Number
BLACK OUT the number in each column for each number
of the SOCIAL SECORI'l'Y NUMBER. For example, if the
Social Security Number is 123 45 6789 - the first
three numbers, 1 2 3. would be blacked under . area, .
4 5 vould be blacked out under .group. and 6 7 8 9
vould be blacked out under 8 serial.Nine blocks
vill be marked one per each pr inted block _lumn.
When requesting SSI verification, use the client
own Social Secur ity Raabe r .
When requesting SSA verification, use the client'
own Social Security Number if at all possible. If
not, you may use the claim account number (CAN).
If using the claim account number, the number will
always end -with a letter or a letter and a number.
For example: 987 65 432lA or 987 65 4321Bl.
If the client 's own Social Security Number is used,
no not complete the next column labeled BIC.
BIC (Beneficiary Identification Code).
Only use this block when using the claim account
number. If the claim number is 987 65 432lA,
BLACK OUT the letter A in the first column, the
Number .0. in the second column and the Number .
in the third column. Always BLACE OUT a letter and
two numbers when u~in9 the BIC block.
- ~
. Page 3 of 10
SOCIAL SECURITY DOCUMENTATION PORM
THIRD PART! QUERY ~ESPO.SE (TPQIl) CARD
MtA IEIUL
I ( I II ~ 'I m ~ ~ i i i i m i i i i i i I ~ i . ~ ~ I . ~I
m II Ii D; 1D. II II IJ S Ie m S fl !1 i) !) i !J 8 f) 8 !J ~ l!J III f) II S !J III !J ~ fiJ
I I I ~ I m I I 1 m ~ I ~ i i i i ~ ~ I m i ~ i ~ i I ~ i I ~ i I ~ i I
I I I I I I I I I ~ I I m I ~ ! ~ ! ~ ! m 8 ~ . ~ ! I ~ ! I ~ i I ~ ~ I
! I ! ! I ! I I ~ I ! i i i i m m i i i I ! 8 ! ~ ! ! S I ! ~ S ~ ~ i
S I I I I I I I I I ~ I I S ffi i m 8 m E m 8 m i m s m I i ~ I i ID I i ~iffiI
I ~ I I m ! m ! ID !
! '
ID ! ID ! ID S ID 8 ID ! ID ~
m m ~ ~ ~ ~ ~ m m ~ m ~ E 8 ~ ! m f m E m E rn t m ~ m rn 8 rn ~ rn ~
I . I I I I I I I 8 I i i i ~ E i 8 i i i i i ~ i ( i i.1 i ~ f ~ ~ I
I I I I I I I I 1 11 i! I!J! f!I E! 8 ~ E i! 81 ~ ~ !I I!J ID 8 i I!J I!J !I ~
'1'8"" '...........~.....~....~.....8....G...G...M.D....8..U.8M......ft.........
TPQT -tmR-IESP0NS1-5 OF 1 ()
REC 123~S67 ABC 82273 12~ (123~S6789:)
1. KSG- 123&1567 ME-o3/11&/85 TPQY AN- 123-115-67891 ID-JOHES UN- PG-OO'.
2. STATUS MBR YES LOO-o3/13/85 SSACes-1I) LOO-o3/13/85 SSR YES LDU-O3/13/85
3. INPUT SOCIAL SECURITY NUMBER 12~S-6789A IWIE C JONES USER CXJDE 123q5
J&. 3RD PAHTY OJERY CXIIrIDEHTIAL SOCIAl. SECUam DATA-CLAIM NUMBER 123..Jt~67B9A
S. INDIVIDUALS OWN SOCIAL SECURTIY IIUHBER: 123-115-67896. Q..ARA JONES FDW.E: ir)RN: 11120/21&EKI'I1UD: 12/80 DIED:
7 . VA1..TD JONES" FOR CU1\A JONES
1200 MUM STREET SEATn.E,- VA 98199
8 . PI YMDlT STATUS CCI)E: C - BENEfTI'S PAID
9 . lET tDmL Y BENEFIT IF P AI AILE : $2Ji5 . 60
10. SPECIAl. PAY DATE: 10/811 PKIOR DUE JM:XJNT: $1174.
1 ,. SPEcw. tDmLY P AYMEHT: . $209 . DO
12. lUCK LUNG PA!MENT. STATUS COOE JI-ICIiPAY lUCK LUNG BENEFIT IF PAYAlU $9999
...
13. MSG-123!1567 DTE-Q3/1&&/85 TPor AJI-123-18s-6789A ID-JONFS UH- PG-002..
'4. DUAL ENTIn.!MENT NUMBER: 132..115-6789B
1 5 . BENEF1T HIS'I'ORI :
1)1 TE : GROSS BENEFIT12/84 S2QS. 60 ~ITED
31M $22 1 . 20 NOT CItED ITED
16. MEDICARE D1TA ENTITLEJ) TERMIJUTm PREMIUM BUY-IX CODE START STOP
17. 1IJSPITAL DlSUJWlCE 12182 . 0.
1 8 . SUP P1.EMEHT AL DISUJWI CE 12/82 . 1 5 .
19. DATE DlSABILm BEGAN 06n9 500 12/82
TPOr -ssR -1tEsPoHsE'
20. KSG-12311S67 DIE-o3/1J&185 TPQ! D: 123-115-6789 ID-JONES UN- ,PG-OO3
21. DIPUJ' SOCIAl. SECURITY lUMBER 123-115-67S9A IUME C JCliES USER DJDE '2~5.
22. 3RD PARTY QUERy aJHFIDENTW.. SUPPLMHTAL SECUlIn INCCME DATA (Ii
123-'15-678923. a.AR1 JONES FDW.E: IQRH: 11/201211 ELIGIBLE: 12/82 DIED:
24. APPLIC1TI~ DATE: 12102/82 mE CF PEJtSCIi: DISABLED INDIVIDUAL
25. CITIZEN/AL.IEJr al)E: IESIDENCY: 12/82
26. MAILIIt:i ADDRESS:
1iAl.TER JCIItS FC8 CURl JCE:S1200 MUM SEATrLE, VA 98199
RES IDEM CE :
2 1 ~ 0 FUN HElL RD !ELLEVUE . KA 9800II
Z7. lET ClJRROO BENEFIT FOR 03/01/85 - FED AKI':. .99.~0 STATE AKI': 138.
28. P YHDrT HISTORY OF' NE1' BENEf1TS PAID :DATE: FEDERAl. AM!: STATE AKT :02/01/85 $ 99.40 $ 38.01102/85 . $ 10.00 S 0.01'01/85 $ 99.40 $ 38.D91O1/~ $ Jl9.00 $ 38.
03/01/sq . 0.00 . 0.
29. PAYMDlT STATUS CXI)E: an - PAY
30. DI~~ rn
mE or PA~h~:
RECURRINj
RECiUUR 'UNDER P A YMD\.
RECURRIN:;
OVERPAYMDa,. RECOVERY
NONE MADE
Wi 11 not appear en an actual prlntcut.
NOTE: Field 1dentif1era vill not. .p~ar for fields vi thout data . w1 th the
. exception or the payment. at.at-us code. .
10.
11.
12.
13.
,..
15.
7 OF 10
lET tDmLY BtNtf'IT IF PAYABLE: - This 1s tM 8OUnt. or the' bene-ficiary ' 8 8Dftth1y check 8nOUnl ArTER 8ed1ca~e premium, deduction
and/or overpayment adjustment.
SPECIAl.. PAY DATE - The PRIOR DUE AMX1HT is the check amount for retro-
act 1 ve benef! t.s pa1d IN the 8pecial pay date shown.
SPECIAl. tDlIHL.Y PAYMDrr - This line will display the 8IDOUnt of the
check pald as the regular 8mthly check when
(, )
Payments are resumed after being 8uspended or deferred and NO
retroactl ve payment. 1s due.. or
(2) The IDOnth1y benefit rate c:hanges due to a recCIDpUutlon CArRO) of
benefl ts AND retroact1 ve benef! ts are due. The retroact1 ve
benefita will be 1ncluded 1n thls reaular 8Ont.h1y check.
1be payment tor (1) and (2) will be FOR the 8Onth d1splayed in the
SPECIAL PAY DATE IIVII 8'ld will be paid 1M the toll0i1ng IDOnth.
lIote: If applicable, only PRIOR DUE AMJ\Jh,. or SPECIAL MJH'I'KL.Y PAYMENT
will be displayed, not both.
. UCK LUNG P1YMDrr - This 1s the payment status and the IIDOUnt of' BL
bene!1 ta. This 1nformt1on will be displayed only if the MBR 1s aware
that .. 18 1nvol ved.
. DATE and PAGE: - This 1nfOMDat1on 1s Identical to line 1 and will be
displayed only 1f there 18 an addi t,lonal pale to the TPQY response.
IXW. DrI11U'KEJIT JIUMBER - When -this line is displayed It indicates
that the bene!lei81'7 on l1ne 6 18 al8O ent! tl8(5 en this other account
to aoc1al aecuritl benefits.
If the beneficiary receives -cn1y ONE ehec1c tram Social Secur1 ty, the
payment D:lUftt 1n MEr MJHTHLJ BEMEnT will include the payment IIDOUnt
tor both accounta.
Ir the beneficiary reCeives ItJRE than one check tram Social Security,
the payment POUft 1ft Er IDmlLJ BDIEf"IT will include only the
peyment DOUnt for the cla1ll IUIIber in line Ji.
BENEFIT HISTORY - The benefit 'history tor the last. 12 months will be
8hown. A benefit history entry, vi.th the effective date, is shown
when there is . change 1n payment 8tatus or benefit rate. CREDITEDMans benefit paid or credited. IOI' CREDITED means benefit not paid
or 8hould not. have been pa1d
9 OF 10
30~Sa.B' llean, t.he recipient 18 disabled for SSI purposes. This dat.a
~ll. only appear if SSI P8ymen~s are for disab1lity and the 8Hw vas
coded in col\Dn 1& or the SSA..IIg1TC.
The 1nro~ticn provided on the TPQt response 18 conf1dential and 8Jst not. be
used or disclosed vi thcut. the conaen~ or the 1nd1 v1dual.
SSA Contact Person:
T e1 ephone :
...
Address:
. Will not appear on actual. response.
-- .- --
VISTA CORPORATION
RESPONSE TO REQUEST FOR INFORMATION
JURISDICTION:
CASE NO:
REQUESTER:
TYPE:
REQUEST NO.
Idaho
A VU-04-01 / A VU-04-
CAP AI
Data Request
DATE PREPARED:
WITNESS:
RESPOND ER:
DEP ARTMENT:
TELEPHONE:
6/21/2004
Don KopczYnski
Chris McCabe
Customer Service
[phone]
REQUEST:
Please provide a copy of any written document in the possession or control of the Company,
whether or not prepared for the Company, assessing, estimating or otherwise discussing the
number of low-income customers served by the Company. To the extent that such document has
been prepared by or for the Company, include all source documents underlying the estimate of
the number of low-income customers.
RESPONSE:
A vista has none of the documents requested. It has been A vista s long-standing practice to not
collect data regarding our individual Customer s personal income levels, so we cannot
distinguish between low-income and non-low-income customers.
VISTA CORPORATION
RESPONSE TO REQUEST FOR INFORMATION
JURISDICTION:
CASE NO:
REQUESTER:
TYPE:
REQUEST NO.
Idaho
A VU-04-01 / A VU-04-
CAP AI
Data Request
DATE PREPARED:
WITNES S
. RESPONDER:
DEP ARTMENT:
TELEPHONE:
06/21/2004
Don KopczYnski
Jon Powell
Utility Strategies
[phone]
REQUEST:
Please provide a detailed written description of all residential energy efficiency programs offered
specifically to low-income customers of the Company, including tariffs filed with the Idaho
Public Utilities Commission.
RESPONSE:
The Company offers a flexible limited income energy-efficiency program encompassing a wide
variety of measures. The programs are implemented in conjunction with community action
agencies (CAA's) operating under annual contracts with Avista. CAA's are given the maximum
possible flexibility in program implementation possible. This flexibility includes the targeting of
measures, conduct of outreach programs and field implementation services. The Company
permits up to 15% of funds to be expended on health and human safety investments in the
residence to enhance the habitability of the home and the longevity of the energy-efficiency
measure. Additionally A vista reimburses the CAA for administrative expenses up to 15% of the
total cost of the energy-efficiency measure.
A non-inclusive list of energy-efficiency measures available to the CAA's for implementation in
limited income households include weatherization (ceiling, wall, floor, infiltration, ventilation),
duct sealing, replacement of compromised windows, furnace efficiency upgrades, water heater
efficiency upgrades, electric-to-gas conversion of space and water heating, residential lighting
measures (compact fluorescent lamps) and installation of high-efficiency air conditioning (if
residents have a medical condition requiring space cooling).
Health and human safety measures are extremely varied but are generally related to shell
integrity (compromised roofs or walls), interior electric wiring hazards and lead paint
identification and abatement.
Limited income customers are also eligible to access all programs offered through the
Company s residential portfolio.