LIHEAP Household Report–Short Format

Low Income Home Energy Assistance Program (LIHEAP) Annual Report on Households Assisted

Documents and Forms

Document Name Document Type
COMM_LIHEAP_OMB HHRInstrShortForm FY23.docx Instruction
COMM_LIHEAP_OMB HHRInstrShortForm FY23.docx Instruction
1 Household Report Short Form RPT_LIHEAP HHR Short Form_2023.xlsx Form
1 Household Report Short Form RPT_LIHEAP HHR Short Form_2023.xlsx Form

Information Collection (IC) Details

IC Title:	LIHEAP Household Report–Short 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			COMM_LIHEAP_OMB HHRInstrShortForm FY23.docx		Yes	Yes	Printable Only
Form	1	Household Report Short Form	RPT_LIHEAP HHR Short Form_2023.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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	151	0	151
Annual IC Time Burden (Hours)	1,510	1,208	302
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.