Information Collection

Win Certification Report (117-a), Sau Certification Record (sau-4), Win Grant Change Report (117-b), Win Grant Change Record (im-9)

IC 116295 under ICR 198309-0980-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type

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Information Collection (IC) Details

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IC Title:	WIN CERTIFICATION REPORT (117-A), SAU CERTIFICATION RECORD (SAU-4), WIN GRANT CHANGE REPORT (117-B), WIN GRANT CHANGE RECORD (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: 35	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	Previously Approved
Annual Number of Responses for this IC	140	-8	148
Annual IC Time Burden (Hours)	5,689	-338	6,027
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.