Weatherization Assistance Program Sub-programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOE F 540.12 Community Scale Form - QPR	Form and Instruction	Modified	Available
Form DOE F 540.11 SERC Form - QPR	Form and Instruction	Modified	Available
Form DOE F 540.9 E&I Form - QPR	Form and Instruction	Modified	Available
Form DOE F 540.8 E&I Form - Grant File	Form and Instruction	Modified	Available
Form DOE F 540.7 E&I Form - Annual Report	Form and Instruction	Modified	Repair queued
Form DOE F 540.6 E&I Form - Historic Preservation	Form and Instruction	Modified	Available
Form DOE F 540.5 E&I Form - Subgrantee Information Worksheet	Form and Instruction	Modified	Repair queued
Form DOE F 540.4 SERC Form - T&TA. Monitoring, and Leveraging Report	Form and Instruction	Modified	Available
Form DOE F 540.4 Community Scale Form - T&TA. Monitoring, and Leveraging Report	Form and Instruction	Modified	Repair queued
Form DOE F 540.2 SERC Form - Annual File Worksheet	Form and Instruction	Modified	Repair queued
Form DOE F 540.2 Community Scale Form - Annual File Worksheet	Form and Instruction	Modified	Available
1910-5157- 2025 Supporting Statement - Final Clean.docx	Supporting Statement A	Uploaded 2025-05-30	Available
60-day FRN 11.25.24.pdf	Supplementary Document	Uploaded 2025-05-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	Community Scale Form - QPR
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	SERC Form - QPR
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	E&I Form - QPR
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	E&I Form - Grant File
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	E&I Form - Annual Report
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	E&I Form - Historic Preservation
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	E&I Form - Subgrantee Information Worksheet
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	SERC Form - T&TA. Monitoring, and Leveraging Report
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	Community Scale Form - T&TA. Monitoring, and Leveraging Report
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	SERC Form - Annual File Worksheet
210941	Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	Form and Instruction	Modified	Community Scale Form - Annual File Worksheet

ICR Details

OMB Control No: 1910-5157	ICR Reference No: 202505-1910-001
Status: Received in OIRA	Previous ICR Reference No: 202205-1910-004
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Katy Kujawski
Title: Weatherization Assistance Program Sub-programs
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/30/2025

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	379	406
Time Burden (Hours)	1,754	1,836
Cost Burden (Dollars)	106,941	108,908

---

Abstract: DOE requests authorization to collect data on the status of WAP E&I, SERC, and Community Scale Pilot activities: units completed, outlays and related information. DOE has also requested authorization to liaise regularly with states to gather real-time data on implementation issues, challenges, and activities.

---

Authorizing Statute(s): PL: Pub.L. 110 - 140 Title V, Subtitle E Name of Law: Energy Efficieny and Conservation Block Grants
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 92920	11/27/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 55555	05/30/2025
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Weatherization Assistance Program Sub-programs - State, Local or Tribal Government	DOE F 540.4, DOE F 540.5, DOE F 540.6, DOE F 540.2, DOE F 540.2, DOE F 540.4, DOE F 540.7, DOE F 540.8, DOE F 540.9, DOE F 540.11, DOE F 540.12	Community Scale Form - Annual File Worksheet ,   SERC Form - Annual File Worksheet ,   Community Scale Form - T&TA. Monitoring, and Leveraging Report ,   SERC Form - T&TA. Monitoring, and Leveraging Report ,   E&I Form - Subgrantee Information Worksheet ,   E&I Form - Historic Preservation ,   E&I Form - Annual Report ,   E&I Form - Grant File ,   E&I Form - QPR ,   SERC Form - QPR ,   Community Scale Form - QPR

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	379	406	0	0	-27	0
Annual Time Burden (Hours)	1,754	1,836	0	0	-82	0
Annual Cost Burden (Dollars)	106,941	108,908	0	0	-1,967	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The changes in previously approved burdens are the result of improved estimated counts of awardees since E&I, SERC, and CSPP awards were made during PY21 and PY22 and wage estimate to updates.

---

Annual Cost to Federal Government: $30,013

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)? Yes

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

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: 05/30/2025

---