Information Collection

LIHEAP Household Report–Short Format

IC 184199 under ICR 202202-0970-011 · OMB 0970-0060.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0060 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
COMM_LIHEAP_OMB HHRInstrShortForm FY22_121721.docx	Instruction
COMM_LIHEAP_OMB HHRInstrShortForm FY22_121721.docx	Instruction
1 Household Report Short Form COMM_LIHEAP_HHR_Short Form_121721.xlsx	Form
1 Household Report Short Form COMM_LIHEAP_HHR_Short Form_121721.xlsx	Form

IC Title:

LIHEAP Household ReportâShort Format

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 45

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
Instruction			COMM_LIHEAP_OMB HHRInstrShortForm FY22_121721.docx		Yes	Yes	Printable Only
Form	1	Household Report Short Form	COMM_LIHEAP_HHR_Short Form_121721.xlsx		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: 151

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	Previously Approved
Annual Number of Responses for this IC	151	3	148
Annual IC Time Burden (Hours)	302	6	296
Annual IC Cost Burden (Dollars)	0	0	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.