Nebraska Department of Environment & Energy

Program Resources/Forms

Nebraska State Plans

2022

• 2022 Nebraska State Weatherization Assistance Program State Plan (PDF) 1.76 MB

2021

• 2021 Nebraska State Weatherization Assistance Program State Plan
  [NDEE Guidance Document 21-031] (PDF) 1.2 MB

2020

• 2020 State Plan for Nebraska Weatherization Assistance Program (PDF) 1.2 MB
  • 2020 Special Terms and Conditions (PDF) 947 KB
  • 2020 Revised Health and Safety Plan (PDF) 1.2 MB

2019

• 2019 State Plan for Nebraska Weatherization Assistance Program (PDF) 664 KB

Standard Work Specifications & Policies

2021

• 2021 Weatherization Policies and Procedures Manual - rev 8-10-2022 (PDF) 1.25 MB
• 2021 RETROFITTING NEBRASKA Field Guide and Installation Standards - rev 8-10-2022 (PDF) 30.2 MB

Reference Manuals

• Lead Safe Weatherization, A Training and Reference Manual for Weatherization Crews
  (PDF 2.4 MB)

Program Health & Safety Forms

• 21-032 WX1 Quality Control Form (PDF)
• 21-032 WX2 Client Education Confirmation of Receipt (PDF)
• 21-034 WX3 Lead Hazard Pre-Renovation Form (PDF)
• 21-035 WX4 Weatherization Deferral Notice (revised) (PDF)
• 21-036 WX5 Mold Assessment and Release Form (PDF)
• 21-037 WX6 Radon Informed Consent/Consent to Perform Work (PDF)
• 21-038 WX7 Home Health and Safety Screening Questionnaire (PDF)
• 21-039 WX8 Health and Safety Checklist (PDF)
• 21-040 WX9 CAZ Depressurization Test (PDF)
• 21-041 WX10 Daily Safety Test Out (PDF)
• 21-042 WX11 Lead Safe Observation Report (PDF)
• 21-043 WX12 Checklist for Determination of Approval (PDF)
• 21-044 WX13 Weatherization Client Questionnaire (PDF)
• 21-045 WX14 Landlord-Tenant Agreement/Permission Form (PDF)
• 21-046 WX15 United States Citizenship Attestation Form (PDF)
• 21-047 WX16 Zero Income Verification (PDF)
• 21-048 WX17 Mechanical System Inspection/Clean & Tune (PDF)
• 21-049 WX18 Mechanical System Repair/Replacement Bid (PDF)
• 21-050 WX19 Frame Home Energy Audit Data Collection (PDF)
• 21-051 WX20 Mobile Home Energy Audit Data Collection (PDF)
• 21-052 WX21 Completion Service Statement (PDF)
• 21-053 WX22 Utility Consumption Information Release (PDF)
• 21-054 WX23 Refrigerator Appliance Agreement (PDF)
• 21-055 WX24 LIHEAP Heating and Cooling Repair or Replacement Program (PDF)
• 21-056 WX25 LIHEAP Heating and Cooling Repair or Replacement Bid Form (PDF)
• 21-057 WX26 LIHEAP Heating and Cooling Repair or Replacement Quality Control
  Inspection Form (PDF)
• 21-058 WX27 Equipment Purchase Request (PDF)
• 21-059 WX28 Request to Remove Items from Weatherization Equipment Inventory (PDF)
• 21-060 WX29 Request to Remove Items from Weatherization Vehicle Inventory (PDF)
• 21-060 WX29 Request to Remove Items from Weatherization Vehicle Inventory (PDF)
• 21-061 WX30 Priority Conditions for Cooling Assistance Checklist (PDF)

Fact Sheets

• Asbestos Fact Sheet (PDF)
• Radon Fact Sheet (PDF)
• Combustion Equipment Safety Fact Sheet (PDF)
• ASHRAE (PDF)

US DOE Program Notices

2022

• Weatherization Program Notice No. 21-3 US DOE Poverty Guidelines
  effective: February 10, 2021 (PDF)

2021

• Weatherization Program Notice No. 21-3 US DOE Poverty Guidelines
  effective: February 10, 2021 (PDF)

2020

• Weatherization Program Notice No. 20-3 US DOE Poverty Guidelines
  effective: February 13, 2020 (PDF)

2019

• Weatherization Program Notice No. 19-3 US DOE Poverty Guidelines
  effective: February 6, 2019 (PDF)

2018

• Weatherization Program Notice No. 18-3, Subject: 2018 Poverty Income Guidelines and Definition of Income
  effective: February 21, 2018 (PDF)

2017

• Weatherization Program Notice No. 17-3, Subject: 2017 Poverty Income Guidelines and Definition of Income
  effective: April 5, 2017 (PDF)
• Weatherization Program Notice No. 17-4
  Subject: Multifamily Housing - Procedure for Certifying Income-Eligible HUD Assisted Buildings
  effective: June 5, 2017 (PDF)
• Weatherization Program Notice No. 17-7
  Subject: Weatherization Health and Safety Guidance
  effective: August 9, 2017 (PDF)
• Weatherization Program Notice No. 17-7 Table of Issues - Contents
  Subject: Weatherization Program Issues (PDF)
• Weatherization Program Notice No. 17-7 Attachment A
  Subject: Additional Health and Safety Guidance Related to Heating Systems (PDF)
• Weatherization Program Notice No. 17-7 HUD Multifamily Certification of Income Eligibility
  Subject: HUD Application (PDF)

US DOE Program Bulletins

2018

• Weatherization Program Bulletin No. 18-1A, Subject: NEO Database BCJO Procedure, effective: February 2018 (PDF)
• Weatherization Program Bulletin No. 18-2A, Subject: NeWAP LIHEAP Augmenting Fund Procedures, effective: February 1, 2018 (PDF)

2017

• Weatherization Program Bulletin No. 17-1A, Subject: Health and Safety Cost Object Flexibility, effective: June 9, 2017 (PDF)
• Weatherization Program Bulletin No. 17-2A, Subject: ASHRAE 62.2 – 2016 Calculation for number of occupants in a dwelling, effective: June 9, 2017 (PDF)

Historical Preservation Act References

• 36 CFR Part 800 - Protection of Historical Properties (PDF)
• Programmatic Agreement between DOE, NEO and Nebraska State Historical Preservation Office Regarding WAP Undertakings 3-17-2010 (PDF)
• Extension of the Duration of Programmatic Agreement (PDF)

Weatherization Brochures

• A Brief Guide to Mold, Moisture, and Your Home (PDF 1.4 MB)
• Even More Dollar and Energy Savings from the recent improvements made on your home. (PDF 1.0 MB)
• The Lead-Safe Certified Guide to Renovate Right (PDF 6.9 MB)

PDF Viewers

Contact us