Long Format for Assisted

Low Income Home Energy Assistance Program (LIHEAP) Household Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0060 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Long Format for Assisted Form
1 Assisted 08 hhsrptst08_assisted households.xls Form
1 Assisted 09 hhsrptst09_assisted households.xls Form
1 Assisted 09 hhsrptst09_assisted households.xls Form

Information Collection (IC) Details

IC Title:	Long Format for Assisted	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 96.82

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Assisted 08	hhsrptst08_assisted households.xls	No	No	Paper Only
Form	1	Assisted 09	hhsrptst09_assisted households.xls	No	No	Paper Only
Form	1	Assisted 09	hhsrptst09_assisted households.xls	No	No	Paper Only

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: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	9,880	9,880
Annual IC Cost Burden (Dollars)	2,236	2,236

Documents for IC

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.