Information Collection

Home Energy Score (HEScore)

IC 239132 under ICR 202403-1910-001 · OMB 1910-5184.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOE F 413.26 Partnership Agreement Home Energy Score (HEScore)	Form and Instruction
Form DOE F 413.24 Partner Implementation Plan Template Home Energy Score (HEScore)	Form and Instruction
Form DOE F 413.40 Remote Service Provider Implementation Template Home Energy Score (HEScore)	Form and Instruction
Form DOE F 413.27 Assessor Candidate Enrollment Home Energy Score (HEScore)	Form and Instruction
Form DOE F 413.25 Tool Data Collection Form Home Energy Score (HEScore)	Form
Form DOE F 414.39 HIE Partner Agreement Home Energy Score (HEScore)	Form and Instruction
Form DOE F 413.41 HIE Partner Quarterly Reporting Form Home Energy Score (HEScore)	Form and Instruction
Instructions for DOE HQ F 413.25.pdf	Instruction
DOE F 413.26 Partnership Agreement DOE HQ F 413.26-Partnership Agreement.pdf	Form and Instruction
DOE F 413.24 Partner Implementation Plan Template DOE HQ F 413.24- Home Energy Score Partner Implementation Plan Templateomb.pdf	Form and Instruction
DOE F 413.40 Remote Service Provider Implementation Template DOE HQ F 413.40- Home Energy Score Remote Service Provider Implementation Plan omb.pdf	Form and Instruction
DOE F 413.27 Assessor Candidate Enrollment DOE HQ F 413.27 -Access Candidate Enrollment Form.pdf	Form and Instruction
DOE F 413.25 Tool Data Collection Form DOE HQ F 413.25- Home Energy Scoring Tool.pdf	Form
DOE F 414.39 HIE Partner Agreement DOE HQ F 413.39- HIE Partner Agreement MTV Final Clean.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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Home Energy Score (HEScore)

Agency IC Tracking Number:

Chris Early

Is this a Common Form? No

IC Status: Modified

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	DOE HQ F 413.26-Partnership Agreement.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	DOE F 413.24	Partner Implementation Plan Template	DOE HQ F 413.24- Home Energy Score Partner Implementation Plan Templateomb.pdf	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 Plan omb.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	DOE F 413.27	Assessor Candidate Enrollment	DOE HQ F 413.27 -Access Candidate Enrollment Form.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 413.25	Tool Data Collection Form	DOE HQ F 413.25- Home Energy Scoring Tool.pdf	Yes	Yes	Fillable Fileable
Instruction			Instructions for DOE HQ F 413.25.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	DOE F 414.39	HIE Partner Agreement	DOE HQ F 413.39- HIE Partner Agreement MTV Final Clean.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

Federal Enterprise Architecture Business Reference Module

Line of Business: Energy

Subfunction: Energy Conservation and Preparedness

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 390

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
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	34,407	-48,000	82,407
Annual IC Time Burden (Hours)	13,536	6,818	6,718
Annual IC Cost Burden (Dollars)	3,035,491	1,106,042	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.