Information Collection

Win 117-a, Win 117-b, Sau-4 Amd Im-9

IC 116294 under ICR 198304-0980-002 · OMB 0980-0157.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0980-0157 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	WIN 117-A, WIN 117-B, SAU-4 AMD IM-9	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	117-A	No	No
Form	117-B	No	No
Form	IM-9	No	No
Form	SAU-4	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 37	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 Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	148	-95	243
Annual IC Time Burden (Hours)	6,027	-3,888	9,915
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.