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Federal forms, ICRs, and supporting documents

Information Collection Request

LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP) LEVERAGING REPORT FORM (3 PARTS)

ICR 199204-0970-002 · OMB 0970-0121 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
116015 LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP) LEVERAGING REPORT FORM (3 PARTS) Form Migrated
ICR Details
0970-0121 199204-0970-002
Historical Active
HHS/ACF
LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP) LEVERAGING REPORT FORM (3 PARTS)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/14/1992
Retrieve Notice of Action (NOA) 04/27/1992
This information collection is approved through 5-95 under the following conditions: ACF will remove Part 2 from the submission, as it duplicates Section 1, of Part 1. The Agency may invite Grantees, a their option, to submit the the resource and cost information from Section 1 on a spreadsheet, if they already have it available. As agreed to by FNS, the Agency will also change the burden estimate t 40 hours, from the 12 hours that was mistakenly printed.
  Inventory as of this Action Requested Previously Approved
05/31/1995 05/31/1995
75 0 0
3,000 0 0
0 0 0
GRANTEES OF THE LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP) BLO GRANT THAT CHOOSE TO APPLY FOR A SHARE OF THE LEVERAGING INCENTIVE FUN MUST SUBMIT A REPORT ANNUALLY. IN ACCORDANCE WITH RECENTLY PASSED ENERGY LEGISLATION, DHHS WILL USE THIS INFORMATION TO ALLOCATE SHARES THE FUND.
None
None
No
1
IC Title Form No. Form Name
LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP) LEVERAGING REPORT FORM (3 PARTS) ACF-119
  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 75 0 0 75 0 0
Annual Time Burden (Hours) 3,000 0 0 3,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/27/1992