Information Collection

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

IC 12639 under ICR 202211-1122-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 STOP Certification amended 2022 clean.docx www.justgrants.gov Form
1122-0001 Certification of Compliance with the Statutory Eligibili STOP Certification amended 2022 clean.docx www.justgrants.gov 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 Requirements of the Violence Against Women Act as Amended, STOP Formula Grant Program	STOP Certification amended 2022 clean.docx	www.justgrants.gov	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.