| OMB Control No. 0970-0060 |
LIHEAP Household Report--Federal Fiscal Year 2009--Short Format |
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| Grantee Name: |
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Date: |
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| Contact Person: |
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Phone: |
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| The LIHEAP Household Report-Short Format is for use by all direct-grant Indian tribes and tribal organizations. The LIHEAP Household Report-Short Format |
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| also is for use by insular areas with annual LIHEAP allotments of less than $200,000. This report provides data on LIHEAP assisted households for Federal |
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| Fiscal Year (FFY) 2009, the period of October 1, 2008 - September 30, 2009. The Report consists of the Recommended Short Format for Assisted Households |
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| below. As the reported data are aggregated, the information in this report is not considered to be confidential. |
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| Both the Recommended Short Format (the Excel file name is hhsrptin.xls) and the instructions on completing the LIHEAP Household Report-Short Format |
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| (the Word file name is hhrptins.doc) can be downloaded at the Forms section of the Office of Community Services LIHEAP web site at: |
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| http://www.acf.dhhs.gov/programs/liheap/grantee_forms/index.html#household_report |
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| The spreadsheet is page protected in order to keep the format uniform. The items requiring a response are not page protected. However, other areas of the |
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| spreadsheet can not be modified. |
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RECOMMENDED SHORT FORMAT FOR LIHEAP ASSISTED HOUSEHOLDS |
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REQUIRED DATA |
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Type |
Number of |
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of |
assisted |
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assistance |
households |
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Heating |
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Cooling |
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Winter/year round crisis |
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Summer crisis |
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Weatherization |
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| Note: Include any notes below for (indicate which type of assistance the note is referencing). |
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