Information Collection

LIHEAP Performance Data Form-Part I

IC 211795 under ICR 201406-0970-003 · OMB 0970-0449.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0449 can be found here:

Documents and Forms

Document Name Document Type
LIHEAP Performance Data Form Instructions (6 4 14) DRAFT.docx Instruction
1 Performance Data Form Performance Data Form DRAFT 6 4 14.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	LIHEAP Performance Data Form-Part I	Agency IC Tracking Number:	OCS

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			LIHEAP Performance Data Form Instructions (6 4 14) DRAFT.docx		Yes	Yes	Fillable Printable
Form	1	Performance Data Form	Performance Data Form DRAFT 6 4 14.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: 51	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	51	51
Annual IC Time Burden (Hours)	179	179
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.