Information Collection

LIHEAP Abbreviated Model Plan

IC 9831 under ICR 201404-0970-012 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Abbreviated Model Plan	Form and Instruction
1 Abbreviated Model Plan OMB-modelabr2010.doc	Form and Instruction

IC Title:

LIHEAP Abbreviated Model Plan

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	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 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-144	144
Annual IC Time Burden (Hours)	-48	48
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.