Information Collection

Low Income Home Energy Assistance (LIHEAP) Leveraging Report

IC 9857 under ICR 201202-0970-005 · OMB 0970-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0121 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Low Income Home Energy Assistance (LIHEAP) Leveraging Report	Form
1 LIHEAP Leveraging Report OMB-levfrm2009[1].doc	Form
levinstr[1].doc 1	IC Document

IC Title:

Low Income Home Energy Assistance (LIHEAP) Leveraging Report

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	LIHEAP Leveraging Report	OMB-levfrm2009[1].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: 70

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	2,660	2,660
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1	levinstr[1].doc	02/17/2012

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