Exhibit_D_-_Monthly_CAPS_Household_Report.xlsx
XLSX spreadsheet 157 KB Posted
- Attached to
- Master Agreement AZ|CTR075550
- Contract number
- CTR075550
- Issued by
- Arizona
About this file
The document appears to be a household benefits reporting template, specifically an Excel spreadsheet for tracking household assistance program data, likely related to a government fuel assistance or social services program. The template is designed for two fiscal years (FFY 24 and FFY 25) and contains comprehensive data collection fields for tracking household demographic and assistance information.
The template includes detailed fields for capturing household-level information such as applicant personal details, address, household composition, vulnerable population indicators (elderly, disabled, children), income levels, and benefit specifics including fuel assistance details. The document is structured to record service codes, benefit amounts, application dates, and heating fuel information, suggesting it is a standardized reporting tool for tracking and managing household assistance program enrollment and support across a government agency or consortium.
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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 .