WIN CERTIFICATION REPORT (117-A), SAU CERTIFICATION RECORD (SAU-4), WIN GRANT CHANGE REPORT (117-B), WIN GRANT CHANGE RECORD (IM-9)

ICR 198409-0980-001

OMB: 0980-0157

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0980-0157 198409-0980-001
Historical Active 198309-0980-002
HHS/HDSO
WIN CERTIFICATION REPORT (117-A), SAU CERTIFICATION RECORD (SAU-4), WIN GRANT CHANGE REPORT (117-B), WIN GRANT CHANGE RECORD (IM-9)
Revision of a currently approved collection   No
Regular
Approved without change 10/23/1984
Retrieve Notice of Action (NOA) 09/10/1984
APPROVED WITH THE FOLLOWING CONDITION:ON FORMS IM-9 AND 117-B A NEW LINE ENTITLED "EMPLOYMENT-WIN PLACEMENT" IS TO BE ADDED AFTER THE "EMPLOYMENT" LINE. THIS IS NEEDED TO ASSESS THE IMPACT OF THE WIN PROGRAM.
  Inventory as of this Action Requested Previously Approved
09/30/1985 09/30/1985 09/30/1984
132 0 140
5,438 0 5,689
0 0 0

THE 117-A AND SAU-4 FORMS ARE USED TO REPORT NUMBER AND TYPE OF CERTIFICATION ACTIVITY. DATA CAN DETERMINE EFFECTIVENESS OF SAU STAFF ON CERTIFICATIONS. THE 117-B AND IM-9 FORMS REPORT CHANGES IN WELFARE GRANTS DUE TO EMPLOYMENT OF REGISTRANTS. AMOUNTS OF GRANT CHANGES AND COST DATA INDICATE PROGRAM RESULTS.

None
None


No

1
IC Title Form No. Form Name
WIN CERTIFICATION REPORT (117-A), SAU CERTIFICATION RECORD (SAU-4), WIN GRANT CHANGE REPORT (117-B), WIN GRANT CHANGE RECORD (IM-9) 117-A, 117-B, IM-9, SAU-4

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 132 140 0 0 -8 0
Annual Time Burden (Hours) 5,438 5,689 0 0 -251 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/10/1984


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