Information Collection

LIHEAP Household Report–Short Format

IC 184199 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 Short Form LIHEAP Household Report–Short Format	Form
Form 1 Household Report Short Form LIHEAP Household Report–Short Format	Form
ATT.2.Household-Report_Short-Form_Renewal_Clean.docx	Instruction
ATT.2.Household-Report_Short-Form_Renewal_Clean.docx	Instruction
1 Household Report Short Form ATT.2.Household-Report_Short-Form_Renewal_Clean.docx	Form
1 Household Report Short Form ATT.2.Household-Report_Short-Form_Renewal_Clean.docx	Form

IC Title:

LIHEAP Household ReportâShort 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:

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: 133

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	133	133
Annual IC Time Burden (Hours)	798	798
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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