Form 1 Carryover Report Form

Attachment B

OMB Control No: 0970-0106

Expiration date: XXXXX

Carryover and Reallotment Report for FY 2020

Estimate due October 1, 2020

Final due December 31, 2020

Grantee _______________________________________ Date _______________________

SECTION 1: For LIHEAP Regular Block Grant Funds Appropriated under P. L. 116-59 and P.L. 116-94 and for FY 2019 Funds Reallotted for FY 2020

Section 2607(b)(2)(B) of the LIHEAP statute (42 USC 8626(b)(2)(B)) requires that at least 90% of funds available must be obligated in the year in which they are appropriated. Not more than 10 percent of the amount payable for a fiscal year may be held for obligation in the succeeding fiscal year.

1.1) Current year amount payable $______________________

(regular block grant funds, reallotted funds, and any

oil overcharge funds designated for use in LIHEAP

for FY 2020)

1.2) 10 percent of amount payable $______________________

(regular block grant funds and reallotted funds)

1.3) Projected unobligated balance $_______________________

(regular block grant funds and reallotted funds)

If line 1.3 is equal to or less than line 1.2, report the amount on line 1.3 as your Carryover amount below. Report $0 funds for reallotment.

If line 1.3 is larger than line 1.2, then report the amount on line 1.2 as your Carryover amount below. Report the difference between line 1.2 and line 1.3 as the reallotment amount below.

Regular Block Grant Carryover amount $_______________________

(Regular block grant funds to be carried over for obligation in the following fiscal year.)

Reallotment amount $______________________ (Regular block grant funds that exceed the 10% carryover amount and are to be returned the Federal government.)

If you report a Regular Block Grant Carryover amount under line 1.3, please provide the following:

1.3)a) Briefly state the reasons that these funds will not be obligated in the fiscal year for which they were allotted

1.3)b) Briefly describe the types of assistance to be provided with the amount of Regular block grant funds that will be held available for the following fiscal year:

SECTION 2: For LIHEAP Supplemental Funds Appropriated under the CARES Act (P. L. 116-136)

The CARES Act (P. L. 116-136) allows grantees to obligate up to 100% of LIHEAP funds in Federal Fiscal Year (FFY) 2020 or 2021. Any share of these funds may be held for obligation in FFY 2021.

2.1) Amount payable $______________________

(CARES Act funds only)

2.2) Carryover amount - projected unobligated balance $______________________

(CARES Act funds only)

2.3) Projected return of funds to HHS/ $______________________

unobligated balance as of 9/30/2021

(CARES Act funds only)

If you report a CARES Act Carryover amount under line 2.2, please provide the following:

2.2)a) Briefly describe the types of assistance to be provided with the amount held available for the following fiscal year:

2.2-2.3) Briefly state the reasons that these funds will not be obligated:

SECTION 3 [RESERVED FOR OTHER SUPPLEMENTAL APPROPRIATIONS]: For LIHEAP Supplemental Funds Appropriated under the [ACT_NAME] (P.L. [PLNO])

The [ACT_NAME] (P.L. [PLNO]) allows grantees to obligate up to [insert]% of LIHEAP funds in Federal Fiscal Year (FFY) 20[insert].

3.1) Amount payable $______________________

([ACT_NAME] funds only)

3.2) Carryover amount - projected unobligated balance $______________________

([ACT_NAME] funds only)

3.3) Projected return of funds to HHS/ $______________________

unobligated balance as of 9/30/20[insert]

([ACT_NAME] funds only)

If you report a [ACT_NAME] Carryover amount under line 2.2, please provide the following:

3.2)a) Briefly describe the types of assistance to be provided with the amount held available for the following fiscal year:

3.2-3.3) Briefly state the reasons that these funds will not be obligated:

______________________________________ _____________________

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