Information Collection

LIHEAP Performance Data Form - Part II Performance Measures

IC 211796 under ICR 201406-0970-003 · OMB 0970-0449.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0449 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 LIHEAP Performance Data Form - Part II Performance Measures	Form
LIHEAP Performance Data Form Instructions (6 4 14) DRAFT.docx	Instruction
1 Performance Data Form Performance Data Form DRAFT 6 4 14.xlsx	Form

IC Title:

LIHEAP Performance Data Form - Part II Performance Measures

Agency IC Tracking Number:

OCS

Is this a Common Form? No

IC Status: New

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	Performance Data Form	Performance Data Form DRAFT 6 4 14.xlsx		Yes	Yes	Fillable Printable
Instruction			LIHEAP Performance Data Form Instructions (6 4 14) DRAFT.docx		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: 51

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	5,100	5,100
Annual IC Cost Burden (Dollars)	5,000,000	5,000,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.