REFERRAL FOR WIN REGISTRATION (INDIVIDUAL)

ICR 198511-0980-001

OMB: 0980-0111

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
116204 Migrated
ICR Details
0980-0111 198511-0980-001
Historical Active 198408-0980-001
HHS/HDSO
REFERRAL FOR WIN REGISTRATION (INDIVIDUAL)
Revision of a currently approved collection   No
Regular
Approved without change 01/28/1986
Retrieve Notice of Action (NOA) 11/06/1985
  Inventory as of this Action Requested Previously Approved
09/30/1986 09/30/1986 12/31/1985
22,104 0 24,560
1,614 0 1,793
0 0 0

THE INCOME MAINTENANCE UNITS (LOCAL WELFARE OFFICE) ARE RESPONSIBLE FO REFERRING NON-EXEMPT AFDC APPLICANTS, RECIPIENTS AND VOLUNTEERS TO THE WIN SPONSOR FOR REGISTRATION. THE IM-3 IS USED TO REFER CLIENTS, PROVIDING INFORMATION ON TIME AND PLACE OF APPOINTMENT, REGISTRATION REQUIREMENT, AND REGISTRANT INFORMATION FOR EMPLOYMENT AND TRAINING.

None
None


No

1
IC Title Form No. Form Name
REFERRAL FOR WIN REGISTRATION (INDIVIDUAL) IM-3

  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 22,104 24,560 0 -2,456 0 0
Annual Time Burden (Hours) 1,614 1,793 0 -179 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
11/06/1985


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