• February 2007
• Instructions for Navigating, Searching, and Printing PDF Documents

Policy and Procedure Exhibits

Chapter 1

• Ex1.1.1A, Percent of Native American Low-Income Households UPDATED JUNE 2007!
• Ex1.2A, Sample Income Guidelines Comparison
• Ex1.2B, Explanation of Different Federal Low-Income Guidelines
• Ex1.2.1A Income Eligibility Waiver Request  UPDATED MARCH 2007!
• Ex1.4.1A, Weatherization Program Property Owner/Agency Agreement
• Ex1.4.1B, Weatherization Program property Owner/Agency Agreement for Multi-Family Buildings
• Ex1.4.1C, Owner-Agency Agreement & The Weatherization Assistance Program 
• Ex1.4.1D, Tenant Rights & The Weatherization Assistance Program
• Ex1.7A, Weatherization Assistance Program Application for Shelters, Group Homes and Transitional Facilities
• Ex1.9A, Historic Preservation Checklist

Chapter 2

• LIHEAP Exhibit 501, Household Information Form
• Ex2A, Income and Residence Verification Checklist
• Ex2B, Household Member and Income Information Form
• Ex2C, Sample Weatherization Program Utility Information Release Waiver
• LIHEAP Exhibit 504D, Declaration of No Income

Chapter 3

• No Exhibits

Chapter 4

• Ex4A, Sample Dispute Resolution Flow Chart
• Ex4B, Client Compliant Form
• Ex4C, Service Review Request
• Ex4D, Dispute Resolution Fact Sheet
• Ex4E, Dispute Resolution Resources

Chapter 5

• Weatherization Fund Matrix - May 2007  UPDATED MAY 2007!
• Ex5.1A, Draft Matrix of Weatherization Measures
• Ex5.1.3A, Solid Fuel Burning Appliance Systems Supplemental Audit
• Ex5.1.6A, Economic Analysis of Refrigerator Replacement
• Ex5.1.8A, Certificate of Insulation
• Ex5.3A, Energy Matchmakers Policy Exception Form
• Ex5.3.1A, Combustion Safety Test Report
• Ex5.3.1B, Techical Support Document
• Ex5.4A, Weatherization-Related Repairs
• Ex5.5A, Weatherization Deferral Form 

Chapter 6

• Ex6.5A, Training and Technical Assistance Expense Form
• Ex6.5B, Peer Exchange Proposal Form
• Ex6.6A, Equipment Purchase Request/Approval Form
• Ex6.6B, Equipment Reserve Fund Application

Chapter 7

• No Exhibits

Chapter 8

• Ex8.3A, Sample Weatherization Contract Face Sheet
• Ex8.3B, Example Exhibit A (Applicable Terms and Conditions)
• Ex8.3C, Sample Weatherization Contract Amendment Face Sheet
• Ex8.3D, Signature Authority
• Ex8.4A, Certification Regarding Debarment, Suspension, or Ineligibility and Voluntary Exclusion – Primary Tier Covered Transactions           
• Ex8.4.1A, Property Owner Release Form
• Ex8.4.1B, Affidavit and Waiver of Lien
• Ex8.5A, Federal Certification Regarding Lobbying
• Standard Form LLL, Disclosure of Lobbying Activities
• Ex8.6A, Working Capital Advance Example One
• Ex8.6B, Working Capital Advance Example Two
• Ex8.6C, Working Capital Advance Example Three
• Ex8.6D, Working Capital Advance Example Four
• Ex8.7A, Sample Request For Reimbursement
• Ex8.7B, Monthly Report For Completed Units
• Ex8.7C, Monthly Report Instructions
• Ex8.8A, Sample Final Contract Closeout Report,
   Form 1: Budget & Actual Costs Statement
• Ex8.8A, Sample Final Contract Closeout Report,
   Form 2:Grant Generated Program Income Report
• Ex8.8A, Sample Final Contract Closeout Report,
   Form 3-1: Inventory (Equipment)
• Ex8.8A, Sample Final Contract Closeout Report,
   Form 3-2: Inventory (Equipment – Vehicle Record)
• Ex8.8A, Sample Final Contract Closeout Report,
   Form 5: Materials Inventory Transfer Voucher
• Ex8.8A, Sample Final Contract Closeout Report,
   Form 6: Owner Refunds Received and Expended
• Ex8.8B, Sample Weatherization Contract Closeout Checklist
  

Chapter 9

• Ex1, Approval to Include Wood Stoves as a Weatherization Assistance Program Material
• Ex2, Knob and Tube Wiring: Revised Policy Superseding Guidance of 7/25/83 and 7/13/88
• Ex3, Excerpts from a June 5, 2000 Study on Insulating Homes Containing Knob and Tube Wiring
• Ex4, Weatherization Assistance Program (WAP) Space Heater Policy
• Ex5, Weatherization Program Notice 02-6 July 12, 2002; "Weatherization Activities and Federal Lead-Based Paint Regulations"
• Ex5  Attachment A, Other Federal Government Regulations Pertaining to Lead-Based Paint
• Ex5  Attachment B, Decision Flow Chart for Applicability of Lead Safe Weatherization (LSW) Measures
• Ex5  Attachment C, Low-Income Home Energy Assitance Program Information Memorandum
• Ex6, WA State Office of Community development TBRA (Tenant-Based Rental Assistance) Program Policies and Procedures
• Ex7, MMWR December 8, 2000 (RR14), 1-13; Recommendations for Blood Lead Screening of Young Children Enrolled in Medicaid: Targeting a Group at High Risk
• Ex8, Pollution Source Survey
• Ex9, Sample Weatherization Mold Inspection and Release Form

Specifications for the Low-Income Weatherization Program Version April 2007 

• Table of Contents
• Section 1    General Requirements
• Section 2    Home Energy Audits
• Section 3    Combustion Safety Testing
• Section 4    Diagnostic Testing
• Section 5    Building Envelope Air Sealing
• Section 6    Attic/Ceiling Insulation
• Section 7    Wall Insulation
• Section 8    Crawlspace/Underfloor/Perimeter Insulation
• Section 9    Moisture Control
• Section 10  Mechanical Ventilation
• Section 11  Dehumidifiers
• Section 12  Heating Systems
• Section 13  Heating and Cooling Ducts
• Section 14  Thermostats
• Section 15  Water Pipe Insulation in Uncontrolled Spaces
• Section 16  Water Heater Insulation
• Section 17  Window Replacement and Repairs
• Section 18  Door Replacement and Repairs
• Section 19  Carbon Monoxide Detectors
• Section 20  Smoke Detectors
• Section 21  Lead-Based Paint
• Section 22  Low-cost No-cost Measures
• Section 23  Lighting Retrofits
• Section 24  Compact Fluorescent Lamps
• Section 25  Refrigerator Replacement
• Section 26  Mobile Homes
• Section 27  Multi-Family
• Section 28  PLACE HOLDER
• Section 29  PLACE HOLDER
• Section 30  Appendix A: Material Specifications
• Section 31  Appendix B: Definitions

Specifications Attachments

• Table of Contents
• Attachment 1      Mold Assessment and Release Sample
• Attachment 2      Pollution Source Survey Sample
• Attachment 3      Matrix of Insulation Measures
• Attachment 4      Matrix of Non-Insulation Measures
• Attachment 5      Combustion Safety Technical Support Document
• Attachment 6      Combustion Safety Test Report Example
• Attachment 7      Diagnostic Test Report Example
• Attachment 8      Building Air Flow Standard (BAS)
• Attachment 9      ASTM E-84-01, Flame Spread and Smoke Development
• Attachment 10    Weatherization Deferral Form Example
• Attachment 11    Policy Notice for Using TREAT
• Attachment 12a  Electric Heating System Work Order Example
• Attachment 12b  Gas Forced Air Heating System Work Order Example
• Attachment 12c  Oil Forced Air Heating System Work Order Example
• Attachment 12d  Oil Burner Retrofit Example
• Attachment 13    Safety Label for Domestic Water Heaters
• Attachment 14    Cost-Effective Guidelines and Examples

Policy and Procedure Manual and Technical Specifications Review Process

• Review Process Timeline
• Proposed Changes Form

Policy and Procedure Manual Amendment Documents and Policy Memos

• May 12, 2006 Policy Memo
• October 4, 2006 Policy Memo
• February 9, 2007 Policy Memo
• February 2007 Update

Technical Specifications Amendment Documents and Policy Memos

• March 21, 2007 Policy Memo
• April 2007 Weatherization Specifications Amendments

Energy OutWest (EOW) Field Guide

• EOW Table of Contents and Section One through Three
• EOW Sections Four through Six and Appendices

• General Weatherization Work Plan Form

2006 Department of Energy Washington State Low-Income Weatherization Assistance Plan

• Final State Plan and Table of Contents.doc
• I.    Introduction.doc
• II.   Annual File.doc
• III.  On-file Information.doc
• IV.  Health and Safety Plan.doc

Request for Reimbursement

• 2007 BPA Weatherization Request for Reimbursement  Form
• 2007 DOE Weatherization Request for Reimbursement Form
• 2005-07 Energy Matchmakers Request for Reimbursement Form
• 2007 LIHEAP Weatherization Request for Reimbursement Form
• 2007 PSE Weatherization Request for Reimbursement Form

Energy Matchmakers Program - 2005-07

• Energy Matchmakers Local Coordinated Plan Narrative
• Sponsor Proposal Forms - Utility
• Sponsor Proposal Forms - Weatherizing Agency
• Monthly In-Kind Match Report
• Energy Matchmakers Policies and Procedures Supplement
• Request for Reimbursement Form 

Weatherization Monitoring Protocol                

• Monitoring Protocol Procedures  UPDATED JULY 2007!
• Premonitoring Questionnaire
• WISHA OSHA Checklist
• Agency Self Assessment
• Local Agency Monitoring Plan
• Monitoring Report Temp July 2006
• Inspection Checklist
• Performance Evaluation Tool
• Compliance Monitor Assignments

Client Energy Education

• Education Guidebook Graphics - English
• Education Guidebook Graphics - Spanish
• Educator's Manual
• Tomorrow's Energy Begins at Home

Weatherization and Repair Agencies List

Technical Development Committee Handbook

Weatherization Work Group Handbook 

Weatherization Assistance Program Disaster Relief Plan 

The following weatherization-related documents are listed in the Housing Services online library:

Why Weatherization Works - National Association for State Community Services Program's information about the weatherization program for public officials

Pollution Occurrence Insurance - Q&A - WAPTAC.org

Pollution Occurrence Liability Insurance Project- Bob Adams, NASCSP

Go back to Weatherization Programs Main Page.

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