LIHEAP Household Report–Long Format

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⚠️ Notice: This information collection may be referencing outdated material.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
COMM_LIHEAP_OMB HHRInstrLongForm FY22_121721.docx Instruction
COMM_LIHEAP_OMB HHRInstrLongForm FY22_121721.docx Instruction
1 Household Report Long Form COMM_LIHEAP_HHR_Long Form_121721.xlsx Form
1 Household Report Long Form COMM_LIHEAP_HHR_Long Form_121721.xlsx Form

Information Collection (IC) Details

IC Title:	LIHEAP Household Report–Long Format	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			COMM_LIHEAP_OMB HHRInstrLongForm FY22_121721.docx		Yes	Yes	Printable Only
Form	1	Household Report Long Form	COMM_LIHEAP_HHR_Long Form_121721.xlsx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	2,408	2,408
Annual IC Cost Burden (Dollars)	0	0

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.