Information Collection

LIHEAP Household Report–Long Format

IC 184198 under ICR 202606-0970-007 · OMB 0970-0060.

Documents and Forms

Document Name Document Type
Form 1 Household Report Long Form LIHEAP Household Report–Long Format Form
ATT.3.COMM_LIHEAP_AT2025_HHR_LongFormInstr_FY26 Clean.docx Instruction
1 Household Report Long Form ATT.1.Household-Report_Long-Form_Renewal_Clean.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	LIHEAP Household ReportâLong 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			ATT.3.COMM_LIHEAP_AT2025_HHR_LongFormInstr_FY26 Clean.docx		Yes	Yes	Printable Only
Form	1	Household Report Long Form	ATT.1.Household-Report_Long-Form_Renewal_Clean.docx		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: 52	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	2,132	2,132
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.

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