OMB control number

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

OMB 0970-0449 · HHS/ACF.

OMB 0970-0449

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.

The latest form for Low Income Home Energy Assistance Program (LIHEAP) Performance Data Form expires 2028-06-30 and is listed under ICR 202503-0970-011.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 1 LIHEAP Performance Data	Form
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
Form 1 LIHEAP Performance Data Form	Form
Form 1 Sub-Grant Recipients (in states with sub-grant recipient managed systems) - Modules II and III	Form
Form 1 LIHEAP Perforrmance Data	Form
Form 1 State Grant Recipients - Modules II and III	Form
Form 1 LIHEAP Performance Data	Form
Form 1 State Grant Recipients - Module I	Form
ADMIN_LIHEAP_Att1StatutoryLanguage_FY2024toFY2026 (002).docx	Supplementary Document
ADMIN_LIHEAP_LPDFOMBSupStmt_States_FY2024toFY2026.docx	Supporting Statement A
Energy Vendors (largest 5 electric, 5 natural gas, 10 fuel oil, and 10 propane vendors per state - average) - Modules II and III	Form
Energy Vendors (largest 5 electric, 5 natural gas, 10 fuel oil, and 10 propane vendors per state - average) - Modules II and III	Form
Energy Vendors (largest 5 electric, 5 natural gas, 10 fuel oil, and 10 propane vendors per state - average) - Modules II and III	Instruction
Sub-Grant Recipients (in states with sub-grant recipient managed systems) - Modules II and III	Form
Sub-Grant Recipients (in states with sub-grant recipient managed systems) - Modules II and III	Form
Sub-Grant Recipients (in states with sub-grant recipient managed systems) - Modules II and III	Instruction
State Grant Recipients - Modules II and III	Form
State Grant Recipients - Modules II and III	Form
State Grant Recipients - Modules II and III	Instruction
State Grant Recipients - Module I	Form
State Grant Recipients - Module I	Form
State Grant Recipients - Module I	Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202503-0970-011	Reinstatement with change of a previously approved collection	2025-04-30
202112-0970-006	Reinstatement with change of a previously approved collection	2021-12-16	Approved with change
202012-0970-004	No material or nonsubstantive change to a currently approved collection	2020-12-09	Approved without change
201802-0970-007	Reinstatement without change of a previously approved collection	2018-02-22	Approved without change
201406-0970-003	Discontinue	2017-09-12	Approved

OMB Details

State Grant Recipients - Module I

Federal Enterprise Architecture: Community and Social Services - Social Services

Information collection instruments
Form	Name	Electronic access	Type
Form 1	LIHEAP Performance Data	Fillable Printable	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.