Low Income Home Energy Assistance (LIHEAP) Leveraging Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Low Income Home Energy Assistance (LIHEAP) Leveraging Report	Form	Modified	Repair queued
OMB-lev-supstat.docx	Supporting Statement A	Uploaded 2017-03-13	Available
LIHEAP Leveraging Report.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-04-29	Available
levinstr[1].doc	Supplementary Document	Uploaded 2012-02-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9857	Low Income Home Energy Assistance (LIHEAP) Leveraging Report	Form	Modified

ICR Details

OMB Control No: 0970-0121	ICR Reference No: 201703-0970-004
Status: Historical Active	Previous ICR Reference No: 201304-0970-007
Agency/Subagency: HHS/ACF	Agency Tracking No: 19402
Title: Low Income Home Energy Assistance (LIHEAP) Leveraging Report
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/16/2017
	Date Received in OIRA: 03/15/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved
Responses	70	0	0
Time Burden (Hours)	2,660	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The data collected will be used to determine the amount of nonfederal home energy resources that LIHEAP grantees have leveraged for low income households in carrying out the provisions of Section 96.87 of the LIHEAP regulations.

---

Authorizing Statute(s): PL: Pub.L. 95 - 35 2607A Name of Law: LIHEAP Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 18857	04/01/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 13456	03/13/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Low Income Home Energy Assistance (LIHEAP) Leveraging Report	1	LIHEAP Leveraging Report

---

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	70	0	0	70	0	0
Annual Time Burden (Hours)	2,660	0	0	2,660	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: No

Burden Reduction Due to:

Short Statement: No change in burden hours

---

Annual Cost to Federal Government: $11,200

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

---

Common Form ICR:  No

---

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: 03/15/2017

---