LOCAL WIN STAFF USE THIS FORM TO
SUMMARIZE APPRAISAL AND EMPLOYABILITY PLAN INFORMATION, AND OBTAIN
REGISTRANTS' SIGNATURES, INDICATING AGREEMENT WITH THE
EMPLOYABILITY PLAN, SAU ASSURES THAT REGISTRANTS ARE CERTIFIED FOR
SOCIAL SERVICES. IT IS USED BY SAU AND E&T AGENCIES TO EXCHANGE
INFORMATION.
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.