Low Income Household Water Assistance Program (LIHWAP) Water Landscape and Equity Research

Water	Utility	Affordability	Survey
Introduction
Thank	you	for	your	interest	in	our	water	utility	survey.	Our	agency,	the	Office	of
Community	Services,	administers	the	Low	Income	Household	Water	Assistance
Program	(LIHWAP),	the	first-ever	low-income	federal	water	assistance	program.
LIHWAP	provides	funding	to	states,	tribes,	and	territories	across	the	United	States
to	help	low-income	households	with	their	water	and	wastewater	bills.	With	this
survey,	we	are	trying	to	better	understand	the	scope	of	water	and	wastewater	debt	so
that	we	can	help	ensure	that	both	households	and	utilities	get	the	money	and
support	they	need.	This	program	directly	benefits	utilities	by	providing	payments	on
behalf	of	customers	who	are	behind	on	their	water	or	wastewater	bills.	This	survey
will	take	30	minutes	or	less	to	complete	and	is	broken	into	6	sections.	Your
information	will	be	kept	private.
PAPERWORK	REDUCTION	ACT	OF	1995	(Pub.	L.	104-13)	STATEMENT	OF	PUBLIC
BURDEN:	The	purpose	of	this	information	collection	is	to	gather	data	related	to
water	and	sewer	costs	so	we	can	better	assist	LIHWAP	grantees.	Public	reporting
burden	for	this	collection	of	information	is	estimated	to	average	30	minutes	per
respondent,	including	the	time	for	reviewing	instructions,	gathering	and
maintaining	the	data	needed,	and	reviewing	the	collection	of	information.	This	is	a
voluntary	collection	of	information.	An	agency	may	not	conduct	or	sponsor,	and	a
person	is	not	required	to	respond	to,	a	collection	of	information	subject	to	the
requirements	of	the	Paperwork	Reduction	Act	of	1995,	unless	it	displays	a	currently
valid	OMB	control	number.	The	OMB	#	is	0970-0531	and	the	expiration	date	is
09/30/2025.	If	you	have	any	comments	on	this	collection	of	information,	please
contact	Gwen	Donley	at	gwendolyn.donley@acf.hhs.gov.

Water	Utility	Affordability	Survey
Utility	Information
The	following	questions	will	ask	you	some	basic	information	about	your	water	utility.
1.	Approximately	how	many	residential	connections	do	you	have	(as	of	December	1,	2022)?	

2.	What	is	the	size	of	your	administrative	staff?	(Administrative	staff	includes	staff	who	are
responsible	for	customer	service,	billing,	support,	etc.)	
Less	than	3
3-5
More	than	5

3.	Which	of	the	following	services	do	you	provide?	(Check	all	that	apply)	
Water
Wastewater

4.	What	is	your	water	source?	(Check	all	that	apply)	
Groundwater
Surface	water

5.	What	is	the	ownership	structure	of	your	utility?	(Check	all	that	apply)	
Publicly	owned	(i.e.,	owned	by	commissions,	municipalities,	etc.)
Privately	owned	(i.e.,	owned	by	a	corporation,	Homeowners	Association,	etc.)
Tribally	owned
Other	(please	specify)

6.	What	is	the	approximate	square	mileage	covering	residences	you	bill	for	water	or
wastewater?	
<5
5-50
51-100
>100

7.	How	is	your	service	area	defined?	(Check	all	that	apply)	
Neighborhood/Community
Municipality
Zip	Code(s)
Public	Service	Area
HOA
County
Other	(please	specify)

8.	Please	expand	on	your	answer	to	question	7.	What	is	your	service	area?	

Water	Utility	Affordability	Survey
Disconnection
9.	At	any	point	during	the	2022	calendar	year,	was	there	a	moratorium	that	disallowed
residential	water	or	sewer	service	shut-offs?	
Yes
No

Water	Utility	Affordability	Survey
Disconnection
The	following	questions	refer	to	residential	accounts	to	whom	you	provide	water	or
wastewater	services.	
10.	Please	estimate	how	many	residential	accounts	received	notice	that	their	water	and/or
wastewater	services	would	be	shut	off	or	disconnected	due	to	nonpayment	at	any	point
during	the	2022	calendar	year:	

11.	Please	estimate	how	many	residential	accounts	had	their	water/wastewater	services	shut
off	or	disconnected	due	to	nonpayment	at	any	point	during	the	2022	calendar	year:	

Water	Utility	Affordability	Survey
Arrearages
The	following	questions	refer	to	residential	accounts	to	whom	you	provide	water	or
wastewater	services.	Please	answer	to	the	best	of	your	ability.
12.	Please	estimate	how	many	residential	accounts	fell	behind	(arrearages)	on	their	water
and/or	wastewater	bills	at	any	point	during	the	2022	calendar	year:	

13.	What	was	the	average	amount	of	money	owed	(arrearages)	per	residential	account	(out	of
those	that	owed	an	arrearage	at	any	point	in	2022)?	

14.	What	is	the	total	amount	of	money	owed	(arrearages)	as	of	December	1,	2022	that	your
utility	is	owed	for	water	and/or	wastewater	bills?	

Water	Utility	Affordability	Survey
EPA	Size	Category
15.	What	is	the	population	size	served	by	your	utility?	
Very	small	(<500	people)
Small	(501-3,300	people)
Medium	(3,301-10,000	people)
Large	(10,001-100,000	people)
Very	Large	(>100,000	people)

Water	Utility	Affordability	Survey
Rates
The	following	questions	refer	to	residential	accounts	to	whom	you	provide	water	or
wastewater	services.	
16.	What	is	your	billing	frequency?	
Monthly
Quarterly
Twice	Annually
Annually

17.	What	is	your	base	rate	for	water	services	per	billing	period	($)?	

18.	How	many	gallons	or	cubic	feet	are	included	in	your	base	rate	per	billing	period?	

19.	Is	your	flow	rate/volume	charge	measured	using	gallons	or	cubic	feet?	
Gallons
Cubic	feet

20.	What	is	your	flow	rate/volume	charge	for	water	services	per	billing	period?	
_____$
per	______	gallon/cubic
foot

21.	Is	your	wastewater	charged	by	a	flat	fee?	
Yes
No

Water	Utility	Affordability	Survey
Rates,	Continued
22.	Wastewater	flat	fee	amount	($):	

Water	Utility	Affordability	Survey
Rates,	Continued
23.	Is	your	wastewater	fee	charged	based	on	water	usage?	
Yes
No

Water	Utility	Affordability	Survey
Rates,	Continued
24.	If	no,	please	explain:		

Water	Utility	Affordability	Survey
Other	Fees,	Shut-Off	Fee
Our	federal	program,	LIHWAP,	is	able	to	cover	costs	related	to	unpaid	or	late	bills,
disconnections,	and	other	fees,	so	we	are	interested	in	learning	about	the	types	of
fees	charged	by	utilities.	In	collecting	this	information,	we	are	not	evaluating	or
critiquing	your	utility's	policies.
25.	Does	your	utility	charge	a	shut-off	fee	(disconnection	or	reconnection	of
water/wastewater)?	
Yes
No

Water	Utility	Affordability	Survey
Other	Fees,	Shut-Off	Amount
26.	Shut-off	fee	amount	($):	

Water	Utility	Affordability	Survey
Other	Fees,	Late	Fee
27.	Does	your	utility	charge	late	fee(s)	on	bills	owed?	
Yes
No

Water	Utility	Affordability	Survey
Other	Fees,	Late	Fee	Amount
28.	Late	fee	amount	($):	

Water	Utility	Affordability	Survey
Other	Fees,	Additional
29.	Does	your	utility	charge	other	fees	(ex:	interest	on	unpaid	balances,	collection	fees)?	
Yes
No

Water	Utility	Affordability	Survey
Other	Fees,	Describe
30.	Please	describe	other	fees:	

31.	If	there	are	any	other	details	related	to	rates,	disconnections,	arrearages,	or	fees	that	you
would	like	to	add,	please	do	so	here:	

Water	Utility	Affordability	Survey
Contact	Information
All	of	your	information	will	be	kept	private.	We	will	use	this	to	make	sure	we	don't
collect	duplicate	responses	and	for	data	quality	verification.
32.	Your	name(s):	

33.	Name	of	the	utility	you	work	for:	

34.	Primary	address	of	the	utility:	
Address
Address	2
City/Town
State/Province

--	select	state	--

ZIP/Postal	Code

35.	Your	job	title(s)	or	role(s):	

36.	Phone	(including	area	code):	

37.	Email	address:	

38.	May	we	contact	you	if	we	have	any	questions	about	your	survey	responses?	
Yes
No

Water	Utility	Affordability	Survey
Closing
Thank	you	for	completing	this	survey.	Your	responses	are	helping	us	understand	the
water	and	wastewater	needs	of	communities	across	the	country,	and	how	programs
like	the	Low	Income	Household	Water	Assistance	Program	can	help	both	households
and	utilities.	We	appreciate	your	time.	If	you	have	any	questions	or	concerns,	please
reach	out	to	Gwendolyn	Donley	at	gwendolyn.donley@acf.hhs.gov.	
39.	If	you	would	like	to	add	any	comments	or	additional	details,	please	do	so	here: