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Win Certification Report, Sau Certification Record, Win Grant Change Report, And Win Grant Change Record
WIN CERTIFICATION REPORT, SAU CERTIFICATION RECORD, WIN GRANT CHANGE REPORT, AND WIN GRANT CHANGE RECORD
OMB: 0980-0020
IC ID: 116098
OMB.report
HHS/HDSO
OMB 0980-0020
ICR 198109-0980-001
IC 116098
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0980-0020 can be found here:
1982-02-11 - Reinstatement without change of a previously approved collection
1981-09-18 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
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.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
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
Federal Enterprise Architecture Business Reference Module
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
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
403,632
0
0
403,632
0
0
Annual IC Time Burden (Hours)
9,915
0
0
9,915
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.