DOE F 540.2 SERC Form - Annual File Worksheet

DOE F 540.2

U.S. Department of Energy WEATHERIZATION ANNUAL FILE WORKSHEET

OMB Control No. 1910-5157 Expiration Date: 5/31/2025

Grant #:

Amendment:

State:

Program Year:

Budget Period:

3. Subgrantees

Grantee	City	Tentative
		Funding*	Units*
Totals

• Funding can include non-DOE sources if included in DOE budget. Units can include those completed with non-DOE funding if included in the DOE budget.

3. Production Schedule

Number of Units (Excluding reweatherized)
Reweatherized Units

Average Unit Costs, Including Reweatherization, Subject to DOE Program Rules*
VEHICLES & EQUIPMENT AVERAGE COST PER DWELLING UNIT (DOE		RULES)
A	Total Vehicles & Equipment ($5,000 or more) Budget
B	Units Weatherized
C	Units Reweatherized
D	Total Dwelling Units to be Weatherized and Reweatherized (B+C)
E	Average Vehicle & Equipment Acquisition Cost per Unit (A divided by D)
AVERAGE COST PER DWELLING UNIT (DOE RULES*)
F	Total Funds for Program Operations**
G	Total Dwelling Units to be Weatherized and Reweatherized (from line D)
H	Average Program Operations Cost per Unit (F divided by G)
I	Average Vehicle & Equipment Acquisition Cost per Unit (from line E)
J	Total Average Cost per Dwelling (H plus I)

• Funding can include non-DOE sources if included in DOE budget. Units can include those completed with non-DOE funding if included in the DOE budget.

** Funds for program operations include expenditures described by 440.18 (c)(1) through (9).

3. Energy Savings

Method used to calculate energy savings: WAP algorithm: Other (describe below): Estimated energy savings (Mbtus):

Other Energy Savings Method Description

3. 
   Training, Technical Assistance, and Monitoring Activities

DOE F 540.2 (08/05)

U.S. Department of Energy WEATHERIZATION ANNUAL FILE WORKSHEET (continued)

Grant #:

Amendment:

State:

Program Year:

Budget Period:

3. 
   DOE-Funded Leveraging Activities

3. Policy Advisory Committee Members

3. State Plan Hearings (send notes, minutes, or transcript to the Regional Office)

Hearing Date:	Newspapers that publicized the hearings and the dates that the notice ran.
If desired, hearing notes or transcripts may be cut and pasted into this space.

3. 
   Adjustments to On-File Information

3. 
   Miscellaneous

DOE F 540.2 (08/05)

OMB Control No. 1910-5127 Expiration Date: 6/30/08

U.S. Department of Energy WEATHERIZATION ASSISTANCE PROGRAM

ANNUAL FILE WORKSHEET INSTRUCTIONS

The Annual File Worksheet is designed to gather specific detail related to the expenditures of the Weatherization grant. Grant Number: The seven-digit Federal identification number assigned to the grant (R999999).

Amendment: If applicable.

State: Name of state or tribal organization submitting the report.

Program Year: The beginning and ending dates (mm/dd/yy) for the Program Year reported.

Budget Period: The starting and ending dates (mm/dd/yy) for the budget period for the WAP program year.

Item Explanation

3. Subgrantees

Grantee Identify each intended subgrantee by name

City Identify the city in which the agency resides

Funding Identify the tentative funding each agency will receive

Units Identify the tentative total of completed units anticipated by the agency with this funding

3. Production Schedule

Total Units Calculate the total units expected to be weatherized for this program year, excluding reweatherized units

Reweatherized Units Calculate the number of reweatherized units to be completed this program year

Average Unit Costs, including Enter data for and add and subtract, as specified to determine the average unit Reweatherization, Subject to costs for units subject to DOE Program/Rules

DOE Program/Rules

3. Energy Savings Identify whether the states will use the WAP Algorithm or Other method to calculate

the estimated energy savings; if other method, description must be entered

Identify the actual estimated energy savings in Mbtus attributed to this funding and program year

3. Training, Technical Assistance and State weatherization training, technical assistance, and monitoring activities Monitoring Activities anticipated during this program year, including any publications or materials planned

3. DOE-Funded Leveraging Activities State weatherization leveraging activities anticipated during this program year using

DOE funding

DOE F 540.2 (08/05)

3. Policy Advisory Committee Members Provide the names, groups, organizations, or agencies represented by the PAC

members and a list of the PAC meeting(s) attendees

3. State Plan Hearings Identify the hearing date(s); a list of the newspapers that publicized the hearings

including the dates the notices ran (notes, minutes, or transcripts should be sent to the appropriate Regional Office)

3. Adjustments to On-File Information Identify any items that have changed since the previous year to the on-file information stored at the state

3. Miscellaneous Identify and anticipated activities that are not routinely administered as part of the

Weatherization Assistance Program (e.g. disaster relief, energy crisis response)