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Work on homes requires DCAA prior approval when estimated labor and material costs of ALL measures will exceed $12,000. Agencies must submit relevant photos and NEAT/MHEA Audit Input and Recommended Measures Reports with the waiver request. The estimated cost includes health and safety, energy efficiency, heating system and water heater work, repair work, and refrigeration appliances using DOE, HEAP, and/or utility funds. This form is required.
Email the completed form to Chris Bracy at chris.bracy@iowa.gov for approval.
$12,000 Expenditure Limit Waiver - Explained
$12,000 Expenditure Limit Waiver (current form date 10-27-16
This form is used to request approval from a utility company to exceed their insulation expenditure limit on a home.
Approval for Additional Insulation Measures (use this one when requesting a waiver from Alliant or Black Hills) (current form date 01-26-16)
Approval for Additional Insulation Measures (use this one when requesting a waiver from MidAmerican) (current form date 01-26-16)
DCAA is offering an optional special project through HEAP that will help eliminate knob and tube wiring for weatherization eligible households. This will enable the program to fully insulate these homes to conserve more energy. The project began January 1st, 2022.
This form is required when requesting funds for the Knob & Tube Special Project.
Email the completed form to Chris Bracy at chris.bracy@iowa.gov for approval.
Knob & Tube Special Project - Explained
Approval for Electrical Measures - FILLABLE PDF (current form date 01-03-2022)
The form below can be completed electronically or printed out and completed by hand. Completion of this form is required for every home on which an energy audit has been conducted.
Weatherization Audit/Inspection Form - Stick-Built Homes (Excel version) (current form date 08-25-16)
Weatherization Audit/Inspection Form - Stick-Built Homes (PDF fillable version) (current form date 08-25-16)
Weatherization Audit/Inspection Form - Manufactured Homes (Excel version) (current form date 08-25-16)
Weatherization Audit/Inspection Form - Manufactured Homes (PDF fillable version) (current form date 08-25-16)
NOTE
- The Excel version is "unlocked" to allow agencies the freedom to change font color, cell fill color, and to highlight important information for crews and contractors. However, NO OTHER CHANGES are to be made to the forms by the agencies.
Agencies must use this form to when the home must be deferred. Deferring work on a dwelling does not mean the dwelling will never be weatherized. If the situation or condition causing the deferral changes, it may be possible to begin or complete the work. This form is required.
Deferral Documentation Form (current form date 02-09-12)
Agencies must use this form to obtain prior approval from DCAA and/or DOE when they wish to dispose of equipment and vehicles (when not replacing the item/s), with an original unit acquisition cost (purchase price) of $5,000 or more (effective 09/29/15). This form is required.
Email the completed form to Christine Taylor at christine.taylor@iowa.gov for approval.
Disposal Request Form (current form date 09-23-15)
Agencies must use this form to obtain prior approval from DCAA and/or DOE when they wish to purchase equipment and vehicles and/or also replace a piece of equipment or a vehicle (e.g., replacing an older truck with a newer one).
This form replaces the Equipment and Vehicle Purchase Request Forms (effective 09/29/15).
When using DOE Weatherization program funds, the purchase must be prior approved by DCAA and DOE when the unit purchase price is $5,000 or more. When using HEAP Weatherization program funds, the purchase must be prior approved by DCAA when the unit purchase price is $5,000 or more. This form is required.
Email the completed form to Christine Taylor at christine.taylor@iowa.gov for approval.
Replacement/Purchase Request Form (current form date 09-23-15)
Agencies must use this form to obtain prior approval from DCAA to establish a user fee that allows other programs to use weatherization equipment and vehicles (effective 09/29/15). This form is required.
Email the completed form to Christine Taylor at christine.taylor@iowa.gov for approval.
User Fee Approval Form (current form date 10-16-15)
When considering a fuel switch, the agency must conduct a cost effectiveness analysis that compares the cost of installing a system with a new fuel source to the costs of installing a system that uses the same fuel source. Written permission to switch fuels must be obtained from the client. The agency must also obtain DCAA approval prior to the fuel switch. This form is required.
Email the completed form to Chris Bracy at chris.bracy@iowa.gov for approval.
Fuel Switching Request (current form date 07-17-15)
The worksheet below must be completed for heating system fuel switches in addition to the Fuel Switching Request form. This form is required.
Need help converting units of energy? See Unit Juggler for help.
Fuel Switching Request Calculations Worksheet (current form date 07-12-16)
Fuel Switching Request Calculations - Completed Sample (current sample date 07-12-16)
The Health and Safety Assessment Findings forms (both Part 1 and Part 2) must be fully completed and used to document possible problems in homes. In all cases, the client and the energy auditor are to sign and date the forms. The original of the signed forms must be in the client file and the copies left with the client. Health and safety testing must also be done after weatherization is completed to ensure the weatherization activities did not create a health and safety problem in the home. These forms are required for every home.
Part 1 - English (current form date 05-21-15)
Part 1 - Spanish (current form date 05-21-15)
Part 2 - English (current form date 04-22-14)
Part 2 - Spanish (current form date 04-22-14)
The Health & Safety Notifications Form must be completed for every home. This is a 2-part NCR form supplied by the State. This form is required for every home.
H&S Notifications (PDF) (uploaded 08/30/19)
When a furnace will be replaced, the energy auditor must either run a complete Manual J calculation or perform an estimated Manual J calculation, using the Heat Loss Calculation Worksheet below.
Heat Loss Calculation Worksheet (current form date 12-31-14)
Heat Loss Calculation Worksheet - Sample
The Landlord Agreement must be signed by the landlord of an eligible dwelling to authorize the weatherization services and agreeing to certain provisions before the rental property can be weatherized. The language in this form is required language. If an agency chooses to use a different form, the required language MUST be included in the alternate form. This form is optional; however, the language in the form is required.
Landlord Agreement (current form date 01-19-11)
Renovation can disturb paint. This includes sanding, cutting, and demolition. Renovation in pre-1978 buildings can create lead dust and chips, which can harm adults and children.
In 2008, the U.S. Environmental Protection Agency (EPA) issued rules for renovation. They apply to renovation in pre-1978 housing (target housing). They also apply to pre-1978 child-occupied facilities (daycare centers, kindergartens). Beginning April 22, 2010, renovators must be certified. They must also follow lead-safe work practices. The Iowa Department of Public Health (IDPH) will carry out these rules in Iowa. Certified individuals are called “lead-safe renovators.”
Refer to the Iowa Department of Public Health Bureau of Lead Poisoning Prevention website for additional information.
Notification Forms
Use of one of these forms is required.
Form 1 - Single Family Dwelling
FORM #1 SAMPLE
Form 2 - Emergency Single Family Dwelling
Form 3 - Owner Multi-Family Dwelling
Form 4 - Occupant Multi-Family Dwelling
Iowa Weatherization Lead-Safe Report
Completed for every pre-1978 structure by the Certified Lead Renovator. Use of this form is required.
Iowa Weatherization Lead-Safe Report (current form date 08-13-13)
LEAD-SAFE REPORT SAMPLE
Lead Exemption Form
Completed when lead safe work practices are not required. Use of this form is optional.
Exempt from Lead Safe Renovation Requirements (current form date 07-02-13)
Lead Safety Brochure
The Iowa Department of Public Health’s Lead Safety Brochure can be found on their website for download. Additional brochures may be ordered by calling 1-800-972-2026. Distribution is required to be done by the Certified Lead Renovator.
Additional Information
Iowa Administrative Code 641 Chapter 69 and Chapter 70 provide detailed guidance regarding lead renovation in Iowa.
Agencies may contact the Iowa Department of Public Health with questions at 1-800-972-2026.
Weatherization of multi-unit dwellings containing 5 or more units requires prior approval from the DCAA and DOE. The appropriate Multi-Unit Dwelling Approval Form must be submitted to the DCAA for approval prior to beginning work.
Agencies are allowed, but not required, to bypass priority lists in order to weatherize multi-unit dwellings.
Buildings 45 years old and older are subject to SHPO review requirements.
The total number of multi-units weatherized must not exceed 20% of total units weatherized by an agency in a program year.
* See PN 10-02Multi-Unit Projects for further guidance.
Email the completed form to Christine Taylor at christine.taylor@iowa.gov for approval.
The form below is to be used when requesting approval from the DCAA to weatherize dwellings that contain between 5 and 24 individually heated units. The NEAT Audit can be used on this type of dwelling.
Multi-Unit Dwelling Approval Form - Projects Using NEAT Audit
This form is to be used when requesting approval from the DCAA to weatherize dwellings that contain more than 24 individually heated units or between 5 and 24 units with a single heating system. The NEAT Audit cannot be used on this type of dwelling; an alternative audit, EA-Quip or TREAT must be used.
Multi-Unit Approval Form - Projects NOT Using NEAT Audit
Below are lists of eligible housing projects.
List #1 (added 06-16-10)
List #2 (added 06-16-10)
List #3 (added 06-16-10)
Participating vendors are to complete the Iowa Weatherization Program Refrigeration Appliance Data Sheet. The form is to be completed for each brand/model of appliance for which the vendor is providing a price quote. The form specifies the style of the appliance, the features of the appliance, the size of the appliance, etc. This form is optional - A spreadsheet including the same information as is in the Appliance Data Sheet, is acceptable (see below).
You may use either format below.
Appliance Data Sheet (current form date 04-18-14)
Refrigeration Appliance Bid Workshee
Participating vendors are agree to and sign the Vendor Agreement which certifies the vendor agrees to the prices quoted and to the conditions listed in the Weatherization General Appendix. This form is required.
Appliance Vendor Agreement (current form date 02-04-14
Use of this form is required when removing/replacing a refrigerator or freezer.
Client Refrigeration Appliance Agreement (current form date 09-04-08)
Agencies are required to take all reasonable precautions against performing work on homes that will subject clients to health and safety risks. Before beginning work on a home, local agencies must take into consideration the health concerns of each occupant, the condition of the dwelling, and the possible effect any work performed will have on the health or medical condition of the occupants. Clients will be required to sign a Release of Liability Form describing possible issues before the audit. If the client refuses to sign the form, no work will be completed on the house and it will be closed incomplete. The original of the signed release must be in the client file, and the copy will be left with the client. This form is required for every home.
Release of Liability - English (current form date 10-01-12)
Release of Liability - Spanish (current form date 10-01-12)
Use the form below when measures to be done on a home fall within the list of exempted measures. * See Program Notice PN 10-03 for further guidance.
Exempt from SHPO Review Form (current form date 04-05-13)
For measures requiring SHPO Comment or Review, please visit the Iowa Department of Cultural Affairs website (updated 04/14/17).
Below is the SHPO Memorandum of Understanding.
Agencies must use this form any time ventilation has been installed in a home. This form is required.
Ventilation and Your Home (current form date 05-17-16)
Ventilation and Your Home - Instruction Sheet
Agencies must use this form for all contracts. Closeouts are due 45 days after the end of each contract. This form is required.
Email the completed form to Christine Taylor at christine.taylor@iowa.gov.
Weatherization Closeout Form (current form date 10-14-04)
The Weatherization Readiness Fund (WRF) is treated as a separate source of funds within the regular DOE contract.
Approval and Amendment:
- Agencies will submit the WRF Application Form as described in Iowa Weatherization Program Notice PN22-02.
- Chris Bracy will review the application and approve if all the guidelines are met.
- Once approval is received by the agency, they may complete the Readiness work.
- When the work is completed, a copy of the invoice and any change orders (with justification) will be submitted to Chris Bracy for review.
- When Chris has finished the final review, a DOE contract amendment will be sent to the agency.
This will eliminate the need for multiple contract amendments because of change orders.
Reporting and WAMS:
All agencies must open the MatTempTemplate in WAMS to add two sequence numbers:
- Sequence number 1140 - add Year House was Built for the Workitem. Put the information in the Note (Location) field. This sequence number must be selected for every house regardless what funds are used. DOE has hinted that this will be a reporting requirement in the near future so it should be added now to prepare for that new requirement.
- Sequence number 1150 -add Weatherization Readiness Funds for the Workitem.
- When reporting readiness work in sequence number 1150, use WRF for the Program. Report materials and labor used make the home ready for weatherization.
- Readiness money will not be included when the monthly financial detail report is run. Agencies will need to manually enter the total WRF for the month on the monthly financial summary report.
Please remember that WRF may only be used on regular DOE homes (not infrastructure funded projects) and the home must be reported to DCAA as a completion.
WRF Application Form (dated 12/2021)