Assessment Application Residential Page 2
Download a blank fillable Assessment Application Residential in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Assessment Application Residential with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2DETERMINE YOUR HOUSEHOLD INCOME RANGE
HOME ENERGY ASSESSMENT FEE SCHEDULE
If your household income is greater than $99,600,
use the chart below to find where it falls in relation
Single-Family Homes
2-4 Unit Residential Building or
Household
to your county’s median income. This will determine
Less than 3,500 Square Feet*
Single Family Homes ≥ 3,500 Square Feet*
Income
the cost, to you, of your home energy assessment (if any).
Cost to
NYSERDA Payment
Cost to
NYSERDA Payment
Range
Customer
to Contractor
Customer
to Contractor
1. Find your county (this is where the home you wish
≤ 200% AMI
- 0 -
$250
- 0 -
$400
to have assessed is located).
201-250% AMI
$50
$200
$80
$320
2. Use the corresponding columns to find the range
251-300% AMI
$100
$150
$160
$240
that includes your household income.
301-350% AMI
$150
$100
$240
$160
3. Check the appropriate box on the front of the application.
351-400% AMI
$200
$50
$320
$80
4. Use your household income range from the chart below
> 400% AMI
Market Rate
- 0 -
Market Rate
- 0 -
and use the chart to the right to determine the cost,
to you, of your assessment (if any).
*Above grade conditioned space.
HOUSEHOLD INCOME GUIDELINES – 2015/2016
Median Household
County Name
≤ 200%
≤ 250%
≤ 300%
≤ 350%
≤ 400%
Income
Albany
$78,300
$156,600
$195,750
$234,900
$274,050
$313,200
Allegany
$52,600
$105,200
$131,500
$157,800
$184,100
$210,400
Broome
$62,900
$125,800
$157,250
$188,700
$220,150
$251,600
Cattaraugus
$49,800
$99,600
$124,500
$149,400
$174,300
$199,200
Cayuga
$62,600
$125,200
$156,500
$187,800
$219,100
$250,400
Chautauqua
$50,900
$101,800
$127,250
$152,700
$178,150
$203,600
Chemung
$63,400
$126,800
$158,500
$190,200
$221,900
$253,600
Chenango
$56,200
$112,400
$140,500
$168,600
$196,700
$224,800
Clinton
$66,000
$132,000
$165,000
$198,000
$231,000
$264,000
Columbia
$74,000
$148,000
$185,000
$222,000
$259,000
$296,000
Cortland
$60,100
$120,200
$150,250
$180,300
$210,350
$240,400
Delaware
$57,500
$115,000
$143,750
$172,500
$201,250
$230,000
Dutchess
$83,100
$166,200
$207,750
$249,300
$290,850
$332,400
Erie
$63,900
$127,800
$159,750
$191,700
$223,650
$255,600
Essex
$59,500
$119,000
$148,750
$178,500
$208,250
$238,000
Franklin
$54,600
$109,200
$136,500
$163,800
$191,100
$218,400
Fulton
$55,500
$111,000
$138,750
$166,500
$194,250
$222,000
Genesee
$65,300
$130,600
$163,250
$195,900
$228,550
$261,200
Greene
$58,400
$116,800
$146,000
$175,200
$204,400
$233,600
Hamilton
$64,100
$128,200
$160,250
$192,300
$224,350
$256,400
Herkimer
$59,500
$119,000
$148,750
$178,500
$208,250
$238,000
Jefferson
$54,000
$108,000
$135,000
$162,000
$189,000
$216,000
Lewis
$55,900
$111,800
$139,750
$167,700
$195,650
$223,600
Livingston
$67,000
$134,000
$167,500
$201,000
$234,500
$268,000
Long Island: Nassau & Suffolk
$105,100
$210,200
$262,750
$315,300
$367,850
$420,400
Madison
$67,700
$135,400
$169,250
$203,100
$236,950
$270,800
Monroe
$67,000
$134,000
$167,500
$201,000
$234,500
$268,000
Montgomery
$57,000
$114,000
$142,500
$171,000
$199,500
$228,000
New York City: Bronx, Kings, New York, Queens, Richmond
$62,500
$125,000
$156,250
$187,500
$218,750
$250,000
Niagara
$63,900
$127,800
$159,750
$191,700
$223,650
$255,600
Oneida
$59,500
$119,000
$148,750
$178,500
$208,250
$238,000
Onondaga
$67,700
$135,400
$169,250
$203,100
$236,950
$270,800
Ontario
$67,000
$134,000
$167,500
$201,000
$234,500
$268,000
Orange
$83,100
$166,200
$207,750
$249,300
$290,850
$332,400
Orleans
$67,000
$134,000
$167,500
$201,000
$234,500
$268,000
Oswego
$67,700
$135,400
$169,250
$203,100
$236,950
$270,800
Otsego
$60,600
$121,200
$151,500
$181,800
$212,100
$242,400
Putnam
$62,500
$125,000
$156,250
$187,500
$218,750
$250,000
Rensselaer
$78,300
$156,600
$195,750
$234,900
$274,050
$313,200
Rockland
$100,200
$200,400
$250,500
$300,600
$350,700
$400,800
Saratoga
$78,300
$156,600
$195,750
$234,900
$274,050
$313,200
Schenectady
$78,300
$156,600
$195,750
$234,900
$274,050
$313,200
Schoharie
$78,300
$156,600
$195,750
$234,900
$274,050
$313,200
Schuyler
$57,300
$114,600
$143,250
$171,900
$200,550
$229,200
Seneca
$57,700
$115,400
$144,250
$173,100
$201,950
$230,800
St. Lawrence
$54,000
$108,000
$135,000
$162,000
$189,000
$216,000
Steuben
$54,500
$109,000
$136,250
$163,500
$190,750
$218,000
Sullivan
$63,200
$126,400
$158,000
$189,600
$221,200
$252,800
Tioga
$62,900
$125,800
$157,250
$188,700
$220,150
$251,600
Tompkins
$78,800
$157,600
$197,000
$236,400
$275,800
$315,200
Ulster
$71,300
$142,600
$178,250
$213,900
$249,550
$285,200
Warren
$62,900
$125,800
$157,250
$188,700
$220,150
$251,600
Washington
$62,900
$125,800
$157,250
$188,700
$220,150
$251,600
Wayne
$67,000
$134,000
$167,500
$201,000
$234,500
$268,000
Westchester
$103,700
$207,400
$259,250
$311,100
$362,950
$414,800
Wyoming
$62,600
$125,200
$156,500
$187,800
$219,100
$250,400
Yates
$60,900
$121,800
$152,250
$182,700
$213,150
$243,600
SFR-HP-AHP-assessment-app-1-v2 1/16
Page 2 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business