Information Collection

Energy Right Program

IC 35855 under ICR 201404-3316-001 · OMB 3316-0019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3316-0019 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 17650 Energy Right Program	Form
17650 Heat Pump Plan Work Completion Form 17650.docx	Form
17651 New Homes Plan Work Completion Form 17651.docx	Form
17652 Water Heater Plan Work Completion Form 17652.docx	Form
17654 Program Implementation Plan 17654.docx	Form
17655 Agreement to Participate - Homeowner 17655.docx	Form
17656 Agreement to Participate - Landlord 17656.docx	Form
17657 Repayment Agreement 17657.docx	Form
17658 Security Agreement 17658.docx	Form
17659 Notice of Right to Cancel 17659.docx	Form

IC Title:

Energy Right Program

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	17650	Heat Pump Plan Work Completion Form	17650.docx	Yes	Yes	Fillable Printable
Form	17651	New Homes Plan Work Completion Form	17651.docx	Yes	Yes	Fillable Printable
Form	17652	Water Heater Plan Work Completion Form	17652.docx	Yes	Yes	Fillable Printable
Form	17654	Program Implementation Plan	17654.docx	Yes	Yes	Fillable Printable
Form	17655	Agreement to Participate - Homeowner	17655.docx	Yes	Yes	Fillable Printable
Form	17656	Agreement to Participate - Landlord	17656.docx	Yes	Yes	Fillable Printable
Form	17657	Repayment Agreement	17657.docx	Yes	Yes	Fillable Printable
Form	17658	Security Agreement	17658.docx	Yes	Yes	Fillable Printable
Form	17659	Notice of Right to Cancel	17659.docx	Yes	Yes	Fillable Printable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title: TVA-29, Energy Program Participant Records

FR Citation: 78 FR 40571

Number of Respondents: 33,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	33,000	4,000	29,000
Annual IC Time Burden (Hours)	10,020	1,320	8,700
Annual IC Cost Burden (Dollars)	190,377	190,377	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.