COMMUNITY DEVELOPMENT CORPORATION OF LONG ISLAND, INC.

WEATHERIZATION ASSISTANCE PROGRAM

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2020-2021 PROGRAM GUIDELINES

CDCLI Has Weatherized More Than 15,000 Long Island Homes In 30 Years

The Weatherization Assistance Program (WAP) assists families and individuals by reducing their

heating/cooling costs and improving the safety of their homes through energy efficiency measures. Owners of

buildings occupied by low-income households are also encouraged to apply for assistance for their buildings.

Program services are delivered through New York State Homes and Community Renewal’s statewide

network of local service providers. CDCLI is the provider of weatherization services for Nassau and

Suffolk Counties.

Funds are made available through the U.S. Department of Energy and U.S. Department of Health &

Human Services.

Funds are available for approximately 400 homes each year. However, due to the high demand for this program,

there is currently a waitlist of approximately 1 year.

Typical repairs may include but are not limited to:

Weatherstripping & Caulking

Attic & Wall Insulation

Heating System Improvements or Replacement

Energy Efficient Lighting

Energy Efficient Refrigeration

Hot Water Tank & Pipe Insulation

Smoke Detectors & CO Detectors

Window Repair or Replacement

Exterior Door Repair or Replacement

Other Minor Repairs That Improve Energy Efficiency

Please note that all repairs are determined after a comprehensive energy audit has been completed by one

of CDCLI’s BPI-certified Building Analysts.

All services are provided without charge or obligation to the occupant of the home. However, owners of

rental buildings are required to invest funds toward the cost of the Weatherization services.

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I. GENERAL ELIGIBILITY CRITERIA

Applicant must reside in Nassau or Suffolk County.

The assisted home must be the primary residence of the applicant.

The assisted home CANNOT be for sale or subject to bankruptcy or foreclosure.

Gross annual household income cannot exceed 60% of the State median income (please see below chart)

OR: Household can be automatically eligible if a member of the household receives Code A Supplemental

Security Income (SSI-Living Alone), Public Assistance, Food Stamps, or HEAP Benefits. Applicants

meeting one of these criteria MUST STILL submit ALL other documents listed below on page 3 except

for income.

For landlords with qualifying tenants, a $200 energy audit fee must be paid upfront, which will be

applied to the landlord’s mandatory 25% contribution (i.e. if costs of total weatherization services

equal $4,000, then the landlord is responsible for $1,000).

II. INCOME GUIDELINES

The household income limits are as set forth below and are in effect as of November 1, 2019. The household

income limits are subject to change as determined by New York State. Income includes all sources of income for

all members of the household – overtime, bonuses, pensions, social security, 401K distributions, tips, etc. Total

household income minus allowable exclusions cannot exceed the maximum gross annual income listed below for

the household size. CDCLI will project the income that will be received for the upcoming 12-month period.

Household Size 1 2 3 4 5 6 7 8

Maximum Annual

Income @60% SMI

$29,928 $39,144 $48,360 $57,564 $66,780 $75,984 $78,020 $86,860

III. PROCESS

Interested participants must submit an application to CDCLI, together with ALL required documentation

(please see checklist below). Applications are available on-line at www.cdcli.org or by calling (631) 471-

1215 x155 or by emailing weatherization@cdcli.org.

CDCLI will conduct an assessment to determine eligibility and notify the applicant that they have been

placed on the waitlist.

Once funding allows, CDCLI will request updated information from the applicant and reassess eligibility.

If eligible, CDCLI will schedule an appointment at the premises for an energy audit to determine the scope

of work, consistent with program requirements. The inspection will be conducted by CDCLI staff.

CDCLI will issue a request for contractor bids detailing the scope of work and award the job to the lowest

responsible bidder. PLEASE NOTE: CDCLI maintains a list of pre-qualified contractors who will be

solicited to perform the work. To be eligible for the program, applicants must agree to utilize a

contractor selected from this pre-qualified list.

The property owner must enter into an agreement with CDCLI setting forth, among other items, the scope

of work, the cost, the completion deadline, the right of CDCLI to inspect the premises and work, and

monitor on-going compliance.

Property owner(s) must sign an Authorization Letter with CDCLI prior to commencement of work (please

see Section IV below)

CDCLI will oversee and manage the work, performing interim and final inspections as required.

Final payment to the contractor will not be made until the property owner(s) have signed a statement

confirming that all work has been performed to full satisfaction. CDCLI does, however, reserve the right

to sign off on the project if the inspector deems the project to be in accordance with all CDCLI guidelines.

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IV. AUTHORIZATION

All property owners will be required to execute an Authorization letter with CDCLI setting forth mutual

understandings and agreements with respect to the program. A copy of the Authorization is attached.

V. REQUIRED DOCUMENTATION: A fully completed and signed Application must be submitted, together

with ALL of the following documentation:

Photo ID: Copy of photo identification for all property owners (i.e. driver’s license, social security

card, passport, etc.)

Electric Bill: Copy of your most recent PSEG Long Island bill or bill from municipal authority

(i.e. Freeport, Greenport, Rockville Centre).

Heating Bill: Copy of fuel usage history. Natural gas customers should submit most recent bill

from National Grid. Oil and propane customers must submit a 12-month history of deliveries

(either a printout out from servicer or all delivery receipts for the 12-month period).

Proof of Ownership: Copy of Property Deed, Property Tax Bill, or Mobile Home Bill of Sale. If

a deceased person is listed on the document, we will also need a copy of the Death Certificate. If

you are having difficulty locating any of these documents, please inform us and we will attempt to

assist by conducting a public records search.

HEAP, Public Assistance, Food Stamps, or Code A SSI: Provide CDCLI with your most recent

award letter and you will automatically qualify. If you do not receive any of the above, you

MUST provide CDCLI documentation for all sources of income for all household members.

OR: Income for All Household Members – See below for applicable documents.

o Social Security/SSI/SSD/TANF/Unemployment/Workers’ Comp/VA Benefits – Copy

of most recent Award Letter or most recent check

o Pension/Retirement – Copy of current letter or printout from company

o Wages – (4) weeks of pay stubs from everyone who is working and living in the home 18

years old and older; dependent full-time students must supply proof of student status.

o Self-Employment – (3) months of business records for (3) months prior to date of

application

o Alimony – Court papers or support collection printout

o Rents – Income tax form, rent receipts, or notarized statement from applicant listing each

apartment and the rent received per month

o Interest/Dividends/Insurance Proceeds/Estates/Trusts – If any of the following is a

regular source of income, please provide a current statement from your bank, brokerage

firm, or insurance company.

o Gifts/Assistance From Family, Friends, Etc. – If you receive regular assistance from any

third party, please provide a notarized letter from them stating what they provide to you

and how often.

VII. COMMITMENT TO FAIR HOUSING & NONDISCRIMINATION

CDCLI is fully committed to enforcing the spirit and the letter of Title VIII of the Civil Rights Act of 1968

(Federal Fair Housing Law), the Fair Housing Amendments Act of 1988, the Americans with Disabilities Act,

the New York Human Rights Act, and the Suffolk County Human Rights Act. CDCLI will not discriminate in

the sale, lease, advertisement or financing of housing against any individual or family because of race, color,

national origin, religion, gender, disability, gender identity, marital status, sexual orientation, veteran/military

status, source of income, familial status or presence of children in a household, or on the basis of any other

protected class.

****************************************************************************************** For additional information, please go to our website at www.cdcli.org or email us at weatherization@cdcli.org.

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WEATHERIZATION ASSISTANCE PROGRAM

FORM #4 - WEATHERIZATION APPLICATION

Applicant Name Social Security # Phone # (w/area code)

Applicant Address (Number + Street, Apt # or Floor, City, Zip Code) County

Alternate contact information:

List any alternate phone numbers or other contact information for applicant

Name of other contact person (if any) Relationship to applicant Phone # (w/area code)

Type of Single-family home OR Multi-family building (number of units: )

Residence OR Manufactured/Mobile home OR Group home/shelter

If rental unit, give landlord/owner name and address:

Who pays for the heat for this residence? Landlord/ Owner OR Tenant

Did this household receive HEAP benefits in the past twelve (12) months? Yes No

If yes, enter your HEAP case number (optional):

Indicate the number of household members who are:

60 years of age or older Black or African American

Children age 17 or younger Hispanic or Latino

Persons with disabilities Native American

Full-time students Asian or Pacific Islander

In the chart below, list all household members, giving their name, sex, and age. Show income sources and

amounts (in whole dollars) received by each household member 16 years or older who is not a full-time student.

Name

Sex

(M/F) Age Source(s) of Income

Weekly

Amount

Monthly

Amount

Yearly

Amount

$ $ $

Total of all income for the household: $ $ $

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ENERGY INFORMATION This section must identify and be signed by the person who is responsible for the energy bills for this residence.

Name:

Building Address:

Number of units in building: Number or location of this unit:

Primary Heating Fuel: Natural Gas Electric Propane Oil Wood Other:

Name and address of Primary Heating Fuel supplier:

Account number:

Do you have a service maintenance agreement with this supplier? Yes No

Any Secondary Heating Fuel that you sometimes use:

Natural Gas Electric Propane Oil Wood Other:

Is this interruptible service? Yes No

Name and address of Secondary Heating Fuel supplier:

Account number:

Do you have a service maintenance agreement with this supplier? Yes No

Electric Utility Provider:

Electric Account Number:

Customer Authorization for Release of Fuel/Energy Bills (for past 2 years and next 2 years)

To Fuel and Electric Suppliers listed on this form: I hereby authorize release of information on my fuel bills, both past and future, to

or its designee. I understand that this information is being made available to help evaluate my energy use patterns

in order to identify potential and actual energy savings resulting from work performed or services offered through

the Weatherization Assistance Program.

Customer signature: Date:

Note: If there are other suppliers that provide you with fuel or energy or with which you have a service

maintenance contract, please attach another sheet with their information (names and addresses, the fuel or energy

service(s) provided, and your account number(s) with those suppliers), so that the Subgrantee can also contact

them for your past and future fuel bills.

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PERSONAL PRIVACY PROTECTION LAW PROVISIONS The New York State Personal Privacy Protection Law (Public Officers Law, Article 6-A) requires in section

94(1)(d) that each subgrantee that maintains a system of records provide each subject from whom it requests

information with certain notifications as provided below.

Name of the agency requesting the information: NYS Homes & Community Renewal

Name of the system of records: Weatherization Data Collection and Reporting System

Agency official responsible for the records: Director, Energy and Rehabilitation Services

NYS Homes & Community Renewal

38-40 State Street

Albany, New York 12207

518-474-5700

Sections 416 and 417 of the Energy Conservation and Production Act (P.L. 94-385) require the State to keep

records for the purposes of monitoring and evaluation and for the preparation of reports to the US Department of

Energy and to the US Department of Health and Human Services, the NYS WAP funding providers.

Program regulations contained in 10 CFR 440.22 require that eligibility for the program be established, which

requires the collection of personal information, including the Social Security number of the applicant. If

information requested on this Weatherization Application is not provided, the applicant's dwelling is not eligible

for WAP funds. This information may also be used to perform data matches with other state and federal agencies,

to verify your eligibility for WAP services.

APPLICANT AFFIRMATION

I subscribe and affirm, under the penalties of law, that the statements made in this application for weatherization

assistance (including statements made in any accompanying papers) have been examined by me and, to the best of

my knowledge and belief, are true and correct. I also state that no person named in this application is subject to

disqualification for weatherization services under the Immigration Reform and Control Act of 1986 (Public Law

99-603). I understand that by signing this application, I consent to any other inquiry to verify or confirm the

information I have given.

I realize that there is to be no lien or mortgage held on the property involved and that this has no effect upon my

Social Security, Public Assistance, or any other income that I may have. Also, the weatherization work done will

not obligate me financially, and I will not be held liable for any injuries or damages occurring on my property

which are not a result of my negligence or malfeasance.

I understand that this application for weatherization assistance does not guarantee that assistance will be granted

but will be used in determining eligibility for the program. Whether or not an eligible applicant will be provided

assistance will depend in part upon the number of applications received, the remaining funds available, and the

priorities to be met by the program.

I have read and understand the provisions of the Personal Privacy Protection Law (above).

Applicant signature: Date:

Applicant’s Representative signature: Date:

Relationship to Applicant

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If you are the owner of this residence, please complete the following home owner certification:

I certify that I am the owner of the property listed as my address on this form. I further certify that I have given

my permission to allow workers at this agency to enter my residence to complete an energy audit, and to do

whatever weatherization work is determined necessary as a result of that audit, on the property listed at the top of

this form. I understand that no payment will be required for this service and that I will not be held liable for any

injuries or damage.

Applicant/Owner signature: Date:

OFFICE USE ONLY

JOB #

Owner verified through: Examination of Deed

Confirmation by Commissioner of Deeds

Confirmation by Tax Assessor’s Office

Other:

On the basis of the information provided by the applicant, the household is determined to be:

Income Eligible: Household of members has a total monthly income of $ .

Documentation of income is attached.

Categorically Eligible: Check all applicable benefits that this household receives:

SSI HEAP Public Assistance NPA Food Stamps

Documentation of benefit(s) attached.

Not Eligible: Household does not meet eligibility criteria.

Intake Worker’s signature Date

Community Development Corporation of Long Island

2100 Middle Country Road, Suite 300, Centereach, NY 11720

631.471.1215 www.cdcli.org

I, consent to have CDCLI evaluate my home located

{Name}

at , a residence that I own.

{Property Address}

I acknowledge that this evaluation will be conducted by CDCLI Home Improvement &

Optimization staff, and that CDCLI will determine the scope of work to be completed at your

residence based on the program guidelines of the program that you are participating in.

I acknowledge that I understand CDCLI must abide by ALL applicable program guidelines as a

recipient of public grant monies, and that CDCLI will develop project scopes of work based on

need. Furthermore, I acknowledge that CDCLI reserves the right to make ALL final determinations

pertaining to the project scope of work, and that I will be at risk of losing assistance should I choose

not to move forward with the proposed scope of work.

{Signature}

Print Name:

Date: