Application Requirements for the Low Income Home Energy Assistance Program (LIHEAP) Model Plan

Forms and Documents

Document Name	Status
Form 1 LIHEAP Abbreviated Model Plan Form and Instruction	Modified
Form 1 LIHEAP Program Integrity Assessment and Plan Form and Instruction	Modified
Form 1 LIHEAP Detailed Model Plan Form and Instruction	Modified
OMB-supstat-MP-10full[1].DOC Supporting Statement A	2010-12-28

IC Document Collections

IC ID	Document Title	Status
9831	LIHEAP Abbreviated Model Plan Form and Instruction	Modified
192860	LIHEAP Program Integrity Assessment and Plan Form and Instruction	Modified
185539	LIHEAP Detailed Model Plan Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0075	ICR Reference No: 201012-0970-008
Status: Historical Active	Previous ICR Reference No: 201005-0970-002
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Application Requirements for the Low Income Home Energy Assistance Program (LIHEAP) Model Plan
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/25/2011
	Date Received in OIRA: 12/29/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	36 Months From Approved	04/30/2011
Responses	432	0	360
Time Burden (Hours)	336	0	283
Cost Burden (Dollars)	0	0	0

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Abstract: The data collected will be used as the application for LIHEAP block grant funding to determine the state, tribal and territorial grantees of LIHEAP funds for each fiscal year in order to carry out the requirements of Section 2605(b) of the LIHEAP statute.

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Authorizing Statute(s): US Code: 42 USC 8624 Name of Law: Low Income Energy Assistance Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 27560	05/17/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 71447	11/23/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
LIHEAP Abbreviated Model Plan	1	Abbreviated Model Plan
LIHEAP Detailed Model Plan	1	Detailed Model Plan
LIHEAP Program Integrity Assessment and Plan	1	Integrety Assessment

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	432	360	0	0	72	0
Annual Time Burden (Hours)	336	283	0	36	17	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There has been program change resulting from the addition of the LIHEAP Program Integrity Assessment Supplement which added 36 hours from the previous request. In addition, there was an adjustment which added 16.5 hours for a total request of 335.5 hours.

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Annual Cost to Federal Government: $12,975

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/29/2010

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