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Sub-Grantees (in states with sub-grantee managed systems) - Modules II and III
Low Income Home Energy Assistance Program (LIHEAP) Performance Data Form
OMB: 0970-0449
IC ID: 230202
OMB.report
HHS/ACF
OMB 0970-0449
ICR 202112-0970-006
IC 230202
( )
Documents and Forms
Document Name
Document Type
Form 1
Sub-Grantees (in states with sub-grantee managed systems) - Modules II and III
Form
LIHEAP Performance Data Form Instructions – CLEAN.docx
Instruction
LIHEAP Performance Data Form Instructions – CLEAN.docx
Instruction
1 LIHEAP Performance Data Form
ADMIN_LIHEAP_OMBSSAtt2Form_FY2021.xlsx
Form
1 LIHEAP Performance Data Form
ADMIN_LIHEAP_OMBSSAtt2Form_FY2021.xlsx
Form
ADMIN_LIHEAP_LPDFPopupInstrs_FY2021.docx
LPDF Popup Instructions
IC Document
ADMIN_LIHEAP_LPDFPopupInstrs_FY2021.docx
LPDF Popup Instructions
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Sub-Grantees (in states with sub-grantee managed systems) - Modules II and III
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 Performance Data Form
ADMIN_LIHEAP_OMBSSAtt2Form_FY2021.xlsx
Yes
Yes
Fillable Printable
Instruction
LIHEAP Performance Data Form Instructions – CLEAN.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
100
0
100
0
0
0
Annual IC Time Burden (Hours)
800
0
800
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
LPDF Popup Instructions
ADMIN_LIHEAP_LPDFPopupInstrs_FY2021.docx
12/13/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.