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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type

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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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded

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