LIHEAP Abbreviated Model Plan

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 1 LIHEAP Abbreviated Model Plan Form and Instruction
1 Abbreviated Model Plan OMB-modelabr2010.doc Form and Instruction

Information Collection (IC) Details

IC Title:	LIHEAP Abbreviated Model Plan	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Abbreviated Model Plan	OMB-modelabr2010.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 144	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	144	29	115
Annual IC Time Burden (Hours)	48	10	38
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.