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	Removed
Form 1 Plan (future years) Form and Instruction	New
Form 1 LIHEAP Program Integrity Assessment and Plan Form and Instruction	Removed
Form 1 LIHEAP Detailed Model Plan Form and Instruction	Removed
LIHEAP Model Plan Supporting Statement 06 23 2014.docx Supporting Statement A	2014-06-23

IC Document Collections

IC ID	Document Title	Status
9831	LIHEAP Abbreviated Model Plan Form and Instruction	Removed
211409	Plan (future years) Form and Instruction	New
211408	PLAN (first year-FY 2015)	New
192860	LIHEAP Program Integrity Assessment and Plan Form and Instruction	Removed
185539	LIHEAP Detailed Model Plan Form and Instruction	Removed

ICR Details

OMB Control No: 0970-0075	ICR Reference No: 201404-0970-012
Status: Historical Active	Previous ICR Reference No: 201012-0970-008
Agency/Subagency: HHS/ACF	Agency Tracking No: ocs
Title: Application Requirements for the Low Income Home Energy Assistance Program (LIHEAP) Model Plan
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/23/2014
	Date Received in OIRA: 04/29/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2017	36 Months From Approved	06/30/2014
Responses	420	0	432
Time Burden (Hours)	525	0	336
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:
	79 FR 4346	01/27/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 22818	04/24/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Plan (future years)	1	Plan
LIHEAP Detailed Model Plan	1	Detailed Model Plan
PLAN (first year-FY 2015)
LIHEAP Program Integrity Assessment and Plan	1	Integrety Assessment
LIHEAP Abbreviated Model Plan	1	Abbreviated Model Plan

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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	420	432	0	-12	0	0
Annual Time Burden (Hours)	525	336	0	189	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The system shows a burden increase because the first year is an annual estimate of 420 hours per year, and years two and three are each 105 hours per year. The average annual burden for the three years is 210 hours per year.

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Annual Cost to Federal Government: $34,650

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: 04/29/2014

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