Application Requirements for the Low Income Home Energy Assistance Program (LIHEAP) Model Plan

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0075 can be found here:

Documents and Forms

Document Name Document Type
Abbreviated Model Plan.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application Requirements for the Low Income Home Energy Assistance Program (LIHEAP) Model Plan	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Abbreviated Model Plan.doc		Yes	Yes	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 115	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	115	-65	180
Annual IC Time Burden (Hours)	38	-65	103
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.