Information Collection

Home Energy Score (HEScore)

IC 239132 under ICR 201912-1910-001 · OMB 1910-5184.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-5184 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOE F 413.26 Home Energy Score (HEScore)	Form and Instruction
Multiple Choice Test Questions (100918).xlsx	Other-Online test
413.25 Instruction for HEScore Data Entry Guidelines v.2019 omb.docx	Instruction
DOE F 413.26 Partnership Agreement 413.26 Home Energy Score Partnership Agreement v2019 omb.docx	Form and Instruction
DOE F 413.24 Partner Implementation Plan Template 413.24 Home Energy Score Partner Implementation Plan Template v2019 omb.doc	Form and Instruction
DOE F 413.40 Remote Service Provider Implementation Template DOE HQ F 413.40 Home Energy Score Remote Service Provider Implementation Template.doc	Form and Instruction
DOE F 413.27 Assessor Candidate Enrollment DOE HQ F 413.27 Assessor Candidate Enrollment 191203.docx	Form and Instruction
DOE F 413.25 Tool Data Collection Form 413.25 A3 - Tool Data Collection Form v.2019 omb.docx	Form
DOE F 414.39 HIE Partner Agreement DOE HQ F 414.39 HIE Partner Agreement 191203.docx	Form and Instruction
DOE F 413.41 HIE Partner Quarterly Reporting Form DOE HQ F 413.41 HIE Partner Quarterly Reporting Form.pdf	Form and Instruction

IC Title:

Home Energy Score (HEScore)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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 and Instruction	DOE F 413.26	Partnership Agreement	413.26 Home Energy Score Partnership Agreement v2019 omb.docx	Yes	Yes	Fillable Fileable
Form and Instruction	DOE F 413.24	Partner Implementation Plan Template	413.24 Home Energy Score Partner Implementation Plan Template v2019 omb.doc	Yes	Yes	Fillable Fileable
Form and Instruction	DOE F 413.40	Remote Service Provider Implementation Template	DOE HQ F 413.40 Home Energy Score Remote Service Provider Implementation Template.doc	Yes	Yes	Fillable Fileable
Form and Instruction	DOE F 413.27	Assessor Candidate Enrollment	DOE HQ F 413.27 Assessor Candidate Enrollment 191203.docx	Yes	Yes	Fillable Fileable
Form	DOE F 413.25	Tool Data Collection Form	413.25 A3 - Tool Data Collection Form v.2019 omb.docx	Yes	Yes	Fillable Fileable
Instruction			413.25 Instruction for HEScore Data Entry Guidelines v.2019 omb.docx	Yes	Yes	Fillable Fileable
Form and Instruction	DOE F 414.39	HIE Partner Agreement	DOE HQ F 414.39 HIE Partner Agreement 191203.docx	Yes	Yes	Fillable Fileable
Form and Instruction	DOE F 413.41	HIE Partner Quarterly Reporting Form	DOE HQ F 413.41 HIE Partner Quarterly Reporting Form.pdf	Yes	Yes	Fillable Fileable
Other-Online test			Multiple Choice Test Questions (100918).xlsx	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Conservation and Preparedness

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 607

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	82,407	82,407
Annual IC Time Burden (Hours)	6,718	6,718
Annual IC Cost Burden (Dollars)	1,929,449	1,929,449

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.