Information Collection

Win Certification Report, Sau Certification Record, Win Grant Change Report, And Win Grant Change Record

IC 116097 under ICR 198008-0980-005 · OMB 0980-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0980-0020 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	WIN CERTIFICATION REPORT, SAU CERTIFICATION RECORD, WIN GRANT CHANGE REPORT, AND WIN GRANT CHANGE RECORD	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	IM 9	No	No
Form	HDS-WIN-117,	No	No
Form	PARTS A&B	No	No
Form	HDS-WIN 117	No	No
Form	PARTS A&B	No	No
Form	SAU 4	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 554	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	403,632	401,432	2,200
Annual IC Time Burden (Hours)	9,915	9,365	550
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.