Information Collection

Low Income Home Energy Assistance (LIHEAP) Leveraging Report

IC 9857 under ICR 201703-0970-004 · OMB 0970-0121.

Documents and Forms

Document Name Document Type
Form 1 Low Income Home Energy Assistance (LIHEAP) Leveraging Report Form
levinstr.doc Leveraging Report Instruction s Instruction
1 LIHEAP Leveraging Report levform.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Low Income Home Energy Assistance (LIHEAP) Leveraging Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form	1	LIHEAP Leveraging Report	levform.doc		Yes	Yes	Fillable Printable
Instruction			levinstr.doc	Leveraging Report Instruction s	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: 70	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	2,660	2,660
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.