Information Collection

Certification of Compliance with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended

IC 12639 under ICR 201312-1122-001 · OMB 1122-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1122-0001 can be found here:

Documents and Forms

Document Name Document Type
Form 1122-0001 Certification of Compliance with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended Form
1122-0001 Certification of Compliance with the Statutory Eligibili 1122-0001 Certification of ComplianceSTOPCERT2015_121415.doc www.usdoj.gov/ovw Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification of Compliance with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended	Agency IC Tracking Number:	1122-0001

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 28 CFR 90

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1122-0001	Certification of Compliance with the Statutory Eligibility	1122-0001 Certification of ComplianceSTOPCERT2015_121415.doc	www.usdoj.gov/ovw	Yes	Yes	Fillable Fileable Signable

Line of Business: Law Enforcement

Subfunction: Citizen Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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