Information Collection

LIHEAP Program Integrity Assessment and Plan

IC 192860 under ICR 201005-0970-002 · OMB 0970-0075.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 LIHEAP Program Integrity Assessment and Plan	Form and Instruction
1 Program Integrity Assessment and Plan Template 2010-AT#6-Model Plan Supplement 05 04 2010_Draft (3) (3).doc	Form and Instruction

IC Title:

LIHEAP Program Integrity Assessment and Plan

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Program Integrity Assessment and Plan Template	2010-AT#6-Model Plan Supplement 05 04 2010_Draft (3) (3).doc		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.