Information Collection

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

IC 116098 under ICR 198109-0980-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type

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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	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
Form	IM 9	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 403,632	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
Annual Number of Responses for this IC	403,632	403,632
Annual IC Time Burden (Hours)	9,915	9,915
Annual IC Cost Burden (Dollars)	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.