Information Collection

Weatherization Assistance Program ARRA-Period Evaluation

IC 198144 under ICR 201106-1910-003 · OMB 1910-5168.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DF2 Long Form_ FINAL.doc	Other-Survey
DF3 Long Form_ FINAL.doc	Other-Survey
DF4 ELECTRIC & NAT GAS BILLS INFO FROM AGENCIES for OMB ARRA FINAL.docx	Other-Survey
DF5_ELECTRIC__NAT_GAS_BILLS_INFO_FROM_UTILITIES_for_OMB_-_Electric_ARRA FINAL.doc	Other-Survey
DF5_ELECTRIC__NAT_GAS_BILLS_INFO_FROM_UTILITIES_for_OMB_-_Gas_ARRA FINAL.doc	Other-survey
DF9 CONTACT INFO FROM AGENCIES FOR OCCUPANT SURVEY for OMB ARRA FINAL.doc	Other-survey
DF11 Weatherization Staff Survey Data Form FINAL.doc	Other-survey
S2 All Agencies_OMB Final.docx	Other-survey
S3 Sampled Agencies Detailed_OMB Final.docx	Other-survey
S4 Occupant Survey ARRA FINAL.doc	Other-survey
S8_Weatherization_Training_Centers_Post-ARRA_Survey FINAL.docx	Other-survey
DF2 Short Form FINAL.doc	Other-survey
DF3 Short Form_ FINAL.doc	Other-survey
DF12 Weatherization Deferral Data Form FINAL.doc	Other-survey
S1 All States_OMB Final.docx	Other-survey
S5_WEATHERIZATION_STAFF_SURVEY_ FINAL.doc	Other-survey

IC Title:

Agency IC Tracking Number:

Tyler Huebner

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey	DF11 Weatherization Staff Survey Data Form FINAL.doc	Yes	Yes	Fillable Fileable
Other-Survey	DF2 Long Form_ FINAL.doc	Yes	Yes	Fillable Fileable
Other-Survey	DF5_ELECTRIC__NAT_GAS_BILLS_INFO_FROM_UTILITIES_for_OMB_-_Electric_ARRA FINAL.doc	Yes	Yes	Fillable Fileable
Other-Survey	DF3 Long Form_ FINAL.doc	Yes	Yes	Fillable Fileable
Other-Survey	DF4 ELECTRIC & NAT GAS BILLS INFO FROM AGENCIES for OMB ARRA FINAL.docx	Yes	Yes	Fillable Fileable
Other-survey	DF5_ELECTRIC__NAT_GAS_BILLS_INFO_FROM_UTILITIES_for_OMB_-_Gas_ARRA FINAL.doc	Yes	Yes	Fillable Fileable
Other-survey	DF9 CONTACT INFO FROM AGENCIES FOR OCCUPANT SURVEY for OMB ARRA FINAL.doc	Yes	Yes	Fillable Fileable
Other-survey	S4 Occupant Survey ARRA FINAL.doc	Yes	Yes	Fillable Fileable
Other-survey	S8_Weatherization_Training_Centers_Post-ARRA_Survey FINAL.docx	Yes	Yes	Fillable Fileable
Other-survey	S2 All Agencies_OMB Final.docx	Yes	Yes	Fillable Fileable
Other-survey	S3 Sampled Agencies Detailed_OMB Final.docx	Yes	Yes	Fillable Fileable
Other-survey	DF2 Short Form FINAL.doc	Yes	Yes	Fillable Fileable
Other-survey	DF3 Short Form_ FINAL.doc	Yes	Yes	Fillable Fileable
Other-survey	DF12 Weatherization Deferral Data Form FINAL.doc	Yes	Yes	Fillable Fileable
Other-survey	S1 All States_OMB Final.docx	Yes	Yes	Fillable Fileable
Other-survey	S5_WEATHERIZATION_STAFF_SURVEY_ FINAL.doc	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Supply

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,404

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 92 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	7,912	7,912
Annual IC Time Burden (Hours)	50,539	50,539
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.