Information Collection

LIHEAP Household Report–Long Format

IC 184198 under ICR 202606-0970-007 · OMB 0970-0060.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Household Report Long Form LIHEAP Household Report–Long Format	Form
Form 1 Household Report Long Form LIHEAP Household Report–Long Format	Form
ATT.3.COMM_LIHEAP_AT2025_HHR_LongFormInstr_FY26 Clean.docx	Instruction
ATT.3.COMM_LIHEAP_AT2025_HHR_LongFormInstr_FY26 Clean.docx	Instruction
1 Household Report Long Form ATT.1.Household-Report_Long-Form_Renewal_Clean.docx	Form
1 Household Report Long Form ATT.1.Household-Report_Long-Form_Renewal_Clean.docx	Form

IC Title:

LIHEAP Household ReportâLong 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: 45 CFR 96.82

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					Yes	Yes	Printable Only
Form	1				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: 52

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
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	2,132	2,132
Annual IC Cost Burden (Dollars)	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.

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