Low Income Home Energy Assistance Program (LIHEAP) Household Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Long Format for Applicants	Form and Instruction	Removed	Available
Edits_SuppStat-HHR 0970-0060.docx	Supporting Statement A	Uploaded 2015-10-16	Available
LIHEAP Household Report.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-04-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9825	Long Format for Applicants	Form and Instruction	Removed
184199	Short Format	Instruction	Modified
184198	Long Format	Instruction	Modified

ICR Details

OMB Control No: 0970-0060	ICR Reference No: 201507-0970-007
Status: Historical Active	Previous ICR Reference No: 201304-0970-010
Agency/Subagency: HHS/ACF	Agency Tracking No: 19397
Title: Low Income Home Energy Assistance Program (LIHEAP) Household Report
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/21/2015
	Date Received in OIRA: 08/05/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2018	36 Months From Approved	10/31/2014
Responses	216	0	52
Time Burden (Hours)	2,192	0	676
Cost Burden (Dollars)	0	0	0

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Abstract: The LIHEAP statute requires the collection of data on the number of households assisted, their income levels, and vulnerability group, by type of LIHEAP assistance, for inclusion in the Secretary's annual LIHEAP Report to Congress. Over the years, the LIHEAP statute, as amended, has expanded the household data requirements. The data are collected through the LIHEAP Household Report which consists of the following: (1) Long Format and (2) Short Format. OCS requests that OMB approval of the LIHEAP Household Report be extended from FY 2016 through FY 2018 to include an unduplicated count of: • Assisted and applicant households, by type of LIHEAP assistance; • Assisted and applicant households, by type of LIHEAP assistance and poverty level; • Assisted households receiving nominal payments of $50 or less; • Assisted households receiving only utility payment assistance; this information will automatically be transferred to the grantee's Performance Data Form. • Assisted households, regardless of the type(s) of LIHEAP assistance, excluding households that only receive nominal payments of $50 or less; • Assisted households, by type of LIHEAP assistance, having at least one member 60 years or older, disabled, or five years old or younger; • Assisted households, by type of LIHEAP assistance, with at least one member age 2 years or under; • Assisted households, by type of LIHEAP assistance, with at least one member ages 3 years through 5 years; and • Assisted households, regardless of the type(s) of LIHEAP assistance, having at least one member 60 years or older, disabled, or five years old or younger.

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Authorizing Statute(s): US Code: 42 USC 8624 Name of Law: Omnibus Reconciliation Act of 1981
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 10697	02/27/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 41044	07/14/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Long Format	1	Household Report Long Form
Short Format	1	Household Report Short Form
Long Format for Applicants	1	Long Format for Applicant

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	216	52	0	164	0	0
Annual Time Burden (Hours)	2,192	676	0	1,516	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes due to program office discretion.

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Annual Cost to Federal Government: $28,908

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/05/2015

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