Low Income Home Energy Assistance Program (LIHEAP) Performance Data Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 LIHEAP Performance Data	Form	Modified	Available
Form 1 Energy Vendors (largest 5 electric, 5 natural gas, 10 fuel oil, and 10 propane vendors per state - average) - Modules II and III	Form	Modified	Missing upstream
Form 1 LIHEAP Performance Data Form	Form	Modified	Available
Form 1 Sub-Grant Recipients (in states with sub-grant recipient managed systems) - Modules II and III	Form	Modified	Missing upstream
Form 1 LIHEAP Perforrmance Data	Form	Modified	Available
Form 1 State Grant Recipients - Modules II and III	Form	Modified	Repair queued
Form 1 LIHEAP Performance Data	Form	Modified	Available
Form 1 State Grant Recipients - Module I	Form	Modified	Missing upstream
ADMIN_LIHEAP_Att1StatutoryLanguage_FY2024toFY2026 (002).docx	Supplementary Document	Uploaded 2025-03-19	Repair queued
ADMIN_LIHEAP_Att1StatutoryLanguage_FY2024toFY2026 (002).docx	Supplementary Document	Uploaded 2025-03-19	Repair queued
ADMIN_LIHEAP_LPDFOMBSupStmt_States_FY2024toFY2026.docx	Supporting Statement A	Uploaded 2025-03-18	Repair queued
ADMIN_LIHEAP_LPDFOMBSupStmt_States_FY2024toFY2026.docx	Supporting Statement A	Uploaded 2025-03-18	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
230203	Energy Vendors (largest 5 electric, 5 natural gas, 10 fuel oil, and 10 propane vendors per state - average) - Modules II and III	Form	Modified	LIHEAP Performance Data
230203	Energy Vendors (largest 5 electric, 5 natural gas, 10 fuel oil, and 10 propane vendors per state - average) - Modules II and III	Form	Modified
230203	Energy Vendors (largest 5 electric, 5 natural gas, 10 fuel oil, and 10 propane vendors per state - average) - Modules II and III	Instruction	Modified
230202	Sub-Grant Recipients (in states with sub-grant recipient managed systems) - Modules II and III	Form	Modified	LIHEAP Performance Data Form
230202	Sub-Grant Recipients (in states with sub-grant recipient managed systems) - Modules II and III	Form	Modified
230202	Sub-Grant Recipients (in states with sub-grant recipient managed systems) - Modules II and III	Instruction	Modified
230201	State Grant Recipients - Modules II and III	Form	Modified	LIHEAP Perforrmance Data
230201	State Grant Recipients - Modules II and III	Form	Modified
230201	State Grant Recipients - Modules II and III	Instruction	Modified
230200	State Grant Recipients - Module I	Form	Modified	LIHEAP Performance Data
230200	State Grant Recipients - Module I	Form	Modified
230200	State Grant Recipients - Module I	Instruction	Modified

ICR Details

OMB Control No: 0970-0449	ICR Reference No: 202503-0970-011
Status: Active	Previous ICR Reference No: 202112-0970-006
Agency/Subagency: HHS/ACF	Agency Tracking No: OCS
Title: Low Income Home Energy Assistance Program (LIHEAP) Performance Data Form
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/06/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/30/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2028	36 Months From Approved
Responses	1,732	0	0
Time Burden (Hours)	23,254	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Low Income Home Energy Assistance Program (LIHEAP) block grant (42 U.S.C. 8621) was established under Title XXVI of the Omnibus Budget Reconciliation Act of 1981, Public Law 97-35. The Office of Community Services (OCS) within the U.S. Department of Health and Human Services (HHS), Administration for Children and Families (ACF) administers LIHEAP at the federal level. The LIHEAP statute requires the program to report to Congress on program impacts annually, to develop performance goals, to ensure that benefits are targeted to those households with the greatest home energy need, and to assure that timely resources are available to households experiencing home energy crises. The LIHEAP Performance Data Form (LPDF) is an annual data collection effort conducted by OCS to collect information from state LIHEAP grant recipients and the District of Columbia to meet statutory requirements and program objectives. Data are collected in five distinct modules: • Module 1 (Grant Recipient Survey) • Module 2 (Required LIHEAP Performance Measures) • Module 2A (Required LIHEAP Performance Measures CARES) • Module 2B (Required LIHEAP Performance Measures ARPA) • Module 3 (Optional LIHEAP Performance Measures) This data is necessary to report to Congress on state-specific and aggregated fiscal and performance measures data for the most recent fiscal year on the program. This request is to extend approval of the current LPDF through June 30, 2025 and for revisions to the form to use beginning July 1, 2025. Revisions include substantive changes to Module 1 to ensure the request is current and clear. See the following section for details on the changes.

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Authorizing Statute(s): PL: Pub.L. 116 - 136 Title VIII of Division B Name of Law: Coronavirus Aid, Relief, and Economic Security Act’’ or the ‘‘CARES Act’’.
   PL: Pub.L. 117 - 2 2911 Name of Law: American Rescue Plan Act of 2021
   US Code: 42 USC 8626(b) Name of Law: Title XXVI of the Omnibus Budget Reconciliation Act of 1981, as amended
  

Citations for New Statutory Requirements: PL: Pub.L. 116 - 136 2607(b) Name of Law: The CARES Act

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 95218	12/02/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 17825	04/29/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Energy Vendors (largest 5 electric, 5 natural gas, 10 fuel oil, and 10 propane vendors per state - average) - Modules II and III	1	LIHEAP Performance Data
State Grant Recipients - Module I	1	LIHEAP Performance Data
State Grant Recipients - Modules II and III	1	LIHEAP Perforrmance Data
Sub-Grant Recipients (in states with sub-grant recipient managed systems) - Modules II and III	1	LIHEAP Performance Data Form

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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	1,732	0	0	1,732	0	0
Annual Time Burden (Hours)	23,254	0	0	23,254	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: This request is for revisions to the LPDF. The changes proposed to the LPDF consist of (1) replacing CARES Act and ARPA items in Module 1 with IIJA items; (2) adding items in Module 1 for reporting carryover use of REACH funds and non-administrative IT enhancements; (3) removing maximum income cutoffs from funding uses; and (4) minor wording changes and item restructuring. The total impacts of these changes results in a reduction in burden estimates, as described in A12. OCS believes that this form’s respondents, by and large, have the capacity to meaningfully separate the performance measures data for households that received benefits supported by CARES Act funds, ARPA funds, or non-supplemental funds. For FY 2020, the respondents were largely successful in reporting similar data broken out by CARES Act funds. Of the 51 states that were required to complete this form and the CARES breakouts on their Household Reports, 96 percent reported total CARES funds used in Module 1. OCS is providing training and technical assistance to the two states that could not report these funds. These changes help LIHEAP’s stakeholders understand the impacts of the supplemental appropriations for FY 2020 and afterwards. They also help state grant recipients isolate the temporary changes to their programs linked to using these supplemental funds from their programs’ overall progress in improving performance. Some grant recipients used CARES or ARPA funds to implement new types of services for their clients. By segmenting out the CARES and ARP recipients, they can get a better understanding of how well those services worked.

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Annual Cost to Federal Government: $80,676

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? Yes

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Common Form ICR:  No

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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: 04/30/2025

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