Exhibit_D_-_Monthly_CAPS_Household_Report.xlsx
XLSX spreadsheet 157 KB Posted
- Attached to
- Master Agreement AZ|CTR075474
- Contract number
- CTR075474
- Issued by
- Arizona
About this file
The document appears to be a household benefits reporting template for a government assistance program, specifically an Excel spreadsheet used to track household information for fuel and other support services. The template is designed for Federal Fiscal Year (FFY) 24 and 25, suggesting it is a standardized reporting tool for a state or federal agency managing household assistance programs.
The template captures comprehensive data about household applicants, including personal identifiers, address details, household composition, and vulnerability indicators such as elderly, disabled, or households with young children. Key data points include household income, number of household members, application date, service codes, and benefit amounts. The document includes columns for tracking fuel benefits, specifically focusing on main heating fuel assistance, with fields for both paid and applied benefits. The template appears to be used for internal tracking and reporting by an agency responsible for managing household support programs, with optional comment sections for agency and DCAD (likely a departmental abbreviation) notes.
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Text version
HOUSEHOLD Template FFY 25 blank
| PROGRAM | Prov ID | HH Information | Vulnerable in Household (Y/N) | Benefit/Assistance Information | Agency | INTERNAL |
| FUND SOURCE CODE | Provider Name (TON) | Applicant |
First Name Applicant Middle Initial Applicant Last
| Name | Applicant | |
| SSN OR CENSUS ID | Applicant | |
| Street Address | Applicant | |
| Unit/Apt # | Applicant | |
| City | Applicant | |
| State | Applicant | |
| Zip Code | # in HH | Household |
Income (30 Days) Elderly (60+) Disabled Child 2 and Under (under 3) (2yrs 364 days yrs or younger) Y/N Child 3 -5 (5 yrds 364 days of age) Y/N Benefit Fuel Fuel (Paid For) Main Heating fuel (Fuel used to Heat the Home) Application date Service Code (regular or Supplemental Benefit Amount AGENCY COMMENT (OPTIONAL) DCAD COMMENT
HOUSEHOLD Template FFY 24 Notes
| PROGRAM | Prov ID | HH Information | Vulnerable in Household (Y/N) | Benefit/Assistance Information | Agency | INTERNAL |
| FUND SOURCE CODE | Provider Name | Applicant |
First Name Applicant Middle Initial Applicant Last
| Name | Applicant | |
| SSN or CID | Applicant | |
| Street Address | Applicant | |
| Unit/Apt # | Applicant | |
| City | Applicant | |
| State | Applicant | |
| Zip Code | # in HH | Household |
Income (30 Days) Elderly (60+) in Home Disabled (Y/N) Child 2 and Under (under 3) (2yrs 364 days yrs or younger) Child 3 -5 (5 yrds 364 days of age) Benefit Fuel Fuel (Paid For) Main Heating fuel (Fuel used to Heat the Home) Application date Service Code Benefit Amount AGENCY COMMENT DCAD COMMENT
File details come from the government source that posted it. Updated .