1. Utility Name _____________________________________ Electric Gas Both
2. Total # of Customers ________________ # of Residential Customers ________________
3. Low-Income Demographics:
A. # < 125% FPL ________________
# of HH w/Children < 5, Seniors, and /or disabled ________________
B. # < 60% of area median income ($________/yr) ________________
# of HH w/Children < 5, Seniors, and /or disabled ________________
4. Rates & Bills - What is:
A. the per kWh (or per therm) charge? ________________
B. the fixed or base charge? ________________
C. the average annual bill for a low-income HH ________________
5. Existing rate discounts/bill assistance programs:
Seniors # in territory _______________ # receiving assistance _______________
Disabled # in territory _______________ # receiving assistance _______________
6. Utility investment - What is the amount of money the utility spends each year on:
A. Weatherization $__________________ # HH served since 1985 ________________
Shareholder % __________ Ratepayer % _________
B. Energy Assistance $__________________ # HH served/year ________________
Shareholder % __________ Ratepayer % _________
7. Is there a voluntary rate payer contribution (Fuel Fund)?
$ collected/year _______________ # HH served/year ________________
8. How much is spent by the utility as write-offs for bad debt? $________________ % L-I _________
9. How much is spent on collection cost for bad debt? $________________ % L-I _________
10. How many low-income HH are in arrears? _________________
What is the estimated cost? $________________
11. What is the number of shutoffs/year? _________________ % L-I _________
Cost to the utility/year $________________
12. How much LIHEAP assistance $ is spent/year in the utility service territory? $______________
TO CALCULATE FUNDS NEEDED TO COVER THE ENERGY BURDEN-BASED BILL ASSISTANCE:
1. Take the # of L-I HH in the service territory. _______________
2. Find their average income per annum. $______________
3. Multiply #2 by 5% (or whatever % of income you choose). $______________
4. Determine the average utility cost/year for #1. $______________
5. Subtract #3 from #4. $______________
6. Multiply #5 by the number of eligible households (#1). $______________
7. Multiply #6 by the desired penetration rate (e.g., 25%, 50%, etc.) $______________
Number 7 is the amount of funds needed to fund the program for direct assistance
8. Now, calculate the amount of money needed to cover your administrative, program support (including eligibility determination and outreach) to serve this number of households $__________________
9. Add numbers 7 and 8 together to get the utility cost (not including their own administration) for the program.
