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IA Paperwork Reduction Act (PRA)

***NOTE: forms that are noted below as being in MS-Word or Excel format should be opened using Google Chrome (due to issues with Internet Explorer (IE) and Excel/Word)***

OMB Control Number Title Description
1076-0017 Application for Financial Assistance and Social Services

Any individual or family may apply for BIA Financial Assistance and Social Services by completing the application process with the assistance of the Social Worker.  A Word version of the Application for Financial Assistance and Social Services (FASS) and Individual Self-Sufficiency (ISP)/Case Plan is available on the Division of Human Services website: https://www.bia.gov/bia/ois/dhs/financial-assistance.

Individual Self-Sufficiency Plan (ISP)/Case Plan
1076-0018 Tribal Colleges & Universities (TCU) Annual Report Form and Instructions

The Tribally Controlled Community College Assistance Act of 1978 (25 U.S.C. 1802-1815) allows for tribally controlled community colleges to apply for grants for the purpose of ensuring continued and expanded education opportunities for American Indian and Alaska Native students. The implementing regulations at 25 CFR 41 establishes the process for tribally controlled colleges to apply for the grants. For more information, please visit www.bie.edu.

Tribal Colleges & Universities (TCU) Application
Tribal Colleges & Universities (TCU) Enrollment Spreadsheet (in Excel)
Tribal Colleges & Universities (TCU) Indian Student Count (ISC) Form (in Excel)
1076-0020 Assignment of Loan Documents and Related Rights

The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk.  The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements.

The forms are available on the Division of Capital Investment website here: https://www.bia.gov/service/loans/ilgp

Claim for Loss
Interest Subsidy Report
Loan Insurance Agreement
Notice of Default
Notice of Insured Loan
Request for Loan Guarantee, Loan Insurance, and/or Interest Subsidy
1076-0020 Loan Guarantee Agreement

The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk.  The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements.

The forms are available on the Division of Capital Investment website here: https://www.bia.gov/service/loans/ilgp

1076-0021 Electrical Service Application

BIA collects information to operate and maintain it's electric power utilities to serve electric power consumers and to fulfill reporting requirements.

1076-0047 Reindeer Sale Permit and Report Form

These forms are collected to monitor and regulation the possession and use of Alaskan reindeer by non-Natives in Alaska.  An applicant must fill out an application for a permit to get a reindeer for any purpose, and is required to report on the status of reindeer annually or when change occurs, including changing prior to the date of the annual report.

1076-0047 Special Use Permit for Public Display of Alaska Reindeer

These forms are collected to monitor and regulation the possession and use of Alaskan reindeer by non-Natives in Alaska.  An applicant must fill out an application for a permit to get a reindeer for any purpose, and is required to report on the status of reindeer annually or when change occurs, including changing prior to the date of the annual report.

Special Use Reindeer Report
1076-0094 Dissolution of Marriage Application

Marriage License Application and Dissolution of Marriage Application

Marriage License Application
1076-0104 Ancestry Chart (BIA-8305) (MS-Word)

Groups seeking Federal acknowledgment under 25 CFR 83 may use the following forms under OMB# 1076-0104 (which includes BIA forms 8304 (Individual History Chart), 8305 (Ancestry Chart) and 8306 (Membership Roll)) to provide a complete list of members of the group seeking recognition.  Groups may submit the information on their own forms.

Ancestry Chart (BIA-8305) (PDF)
Individual History Chart (BIA-8304) (MS-Word)
Individual History Chart (BIA-8304) (PDF)
Membership Roll (BIA-8306) (MS-Word)
Membership Roll (BIA-8306) (PDF)
1076-0114 Haskell Indian Nations University Admission Application

For more information regarding admission to Haskell Indian Nations University, please visit Haskell's website: https://www.haskell.edu/.

For more information regarding admission to Southwestern Indian Polytechnic Institute (SIPI), please visit SIPI's website: https://www.sipi.edu/.

1076-0114 Southwestern Indian Polytechnic Institute (SIPI) Admission Application

For more information regarding admission to Haskell Indian Nations University, please visit Haskell's website: https://www.haskell.edu/.

For more information regarding admission to Southwestern Indian Polytechnic Institute (SIPI), please visit SIPI's website: https://www.sipi.edu/.

1076-0120 Adult Education Annual Report Form

The Bureau of Indian Education (BIE) annually collects information to prioritize programs and measure the success of programs.  This annual report helps manage the resources available to provide education opportunities for adult Indians and Alaska Natives to complete high school graduation requirements and gain new skills and knowledge for their self-enhancement.  For more information on the Adult Education program, please visit www.bie.edu.

1076-0122 Data Elements for Student Enrollment in Bureau-funded Schools

This form is used for by Bureau-funded school registrars to collect information to determine student's eligibility for enrollment in a Bureau-funded school.  If eligible, the information is shared with appropriate schools officials to identify the student's base and supplemental educational and/or residential program needs.

1076-0131 Indian Child Welfare Quarterly and Annual Report

The BIA collects information using the consolidated caseload form, which tribal ICWA program directors complete. BIA uses the information to determine the extent of service needs in local Indian communities, assess ICWA program effectiveness, and provide data for the annual program budget justification.

1076-0134 BIE Indian School Equalization Program (ISEP) Student Transportation Form

This form is used by Bureau-funded Schools to determine the rate per mile and allocation of transportation funds.  The Student Transportation regulations in 25 CFR part 39, subpart G, contain the program eligibility and criteria that govern the allocation of transportation funds.  This information is also collected using a web-based system, Web Education Transportation (Web ET).

1076-0135 477 Financial Report Form and Instructions (Excel)

Reporting System for P.L. 102-477 Demonstration Project

477 Narrative Report
477 Statistical Report and Instructions
1076-0141 Annual Assessment Waiver Application

In order for irrigators to receive water deliveries, information is needed by the BIA to operate and maintain its irrigation projects and fulfill reporting requirements. Water users must apply for water delivery and for a number of other associated services, such as, subsidizing a farm unit, requesting leaching service, requesting water for domestic or stock purposes, building structures or fences in BIA rights-of-way, requesting payment plans on bills, establishing a carriage agreement with a third-party, negotiating irrigation incentives leases, and requesting an assessment waiver.

Incentive Agreement
Land Classification/Designation Application
Request for Customer Information
Request for Irrigation Services
1076-0143 Self-Governance Minimum Data Collection

Tribes and Tribal consortia that have entered into Self-Governance funding agreements are requested to submit certain information as described in 25 CFR part 1000.

1076-0153 Certificate of Degree of Indian or Alaska Native Blood (CDIB) (PDF)

This is the Certificate of Degree of Indian or Alaska Native Blood (CDIB) form. Instructions are included with the form.

 

1076-0157 Form 5-5243 - Performance Bond

Grazing Permits

The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians.  

The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166.  Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass. 

Form 5-5514 - Bid for Grazing Privileges
Form 5-5515 - Grazing Permit
Form 5-5516 - Grazing Permit for Organized Tribes
Form 5-5517 - Free Grazing Permit
Form 5-5519 - Cash Penal Bond for Grazing Permits
Form 5-5520 - Power of Attorney
Form 5-5521 - Certificate and Application for On-and-Off Grazing Permit
Form 5-5522 - Modification of Grazing Permit (Form 5-5515)
Form 5-5523 - Assignment of Grazing Permit
Form 5-5524 - Application for Allocation of Grazing Privileges
Form 5-5525 - Authority to Grant Grazing Privileges on Allotted Lands
Form 5-5528 - Livestock Crossing Permit
Form 5-5529 - Removable Range Improvement Records
1076-0160 BIA 4432 - Verification of Indian Preference for Employment (PDF)

Applicants seeking employment in the Indian Health Service and/or Indian Affairs use this form to establish evidence of Indian preference as part of the application process. The Family History Chart is also used as part of the Indian Preference verification process.

Family History Chart (PDF)
1076-0162 Navajo Partitioned Lands: Grazing Permits (Form 5-5015)

This information is used by the Department of the Interior (DOI), Bureau of Indian Affairs (BIA), and the Navajo Nation to determine eligibility for a Navajo Partitioned Land (NPL) grazing permit and to administer permits once issues.  Information is submitted by individual Navajo tribal members wanting to obtain or modify a grazing permit and by departments and officials of the Navajo Nation.

1076-0162 Navajo Partitioned Lands: Modification of Grazing Permit (Form 5-5022)

This information is used by the Department of the Interior (DOI), Bureau of Indian Affairs (BIA), and the Navajo Nation to determine eligibility for a Navajo Partitioned Land (NPL) grazing permit and to administer permits once issues.  Information is submitted by individual Navajo tribal members wanting to obtain or modify a grazing permit and by departments and officials of the Navajo Nation.

1076-0164 Authorization for Medical Care of a Minor

This is a BIE form which gives permission for a physician, surgeon, or dentist to provide necessary care to a child whose parents are not immediately available.

1076-0176 IDEIA Tribal Count Data Requirements for Part B
IDEIA Tribal Count Data Requirements Part C
1076-0179 BIE Advisory Board for Exceptional Education Membership Nomination Form

This form is used to submit nominations for individuals to serve on the Federal advisory committee, the Advisory Board for Exceptional Children.

1076-0180 Application for Permit to Drill Environmental Assessment Questionnaire

The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land.  The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.

Form 139 - Application for Permit to Drill or Reenter
Form 208 - Well Completion or Recompletion Report and Log
Form 229 - Waterflood Operating Report
Form A - Osage Gas Mining Lease
Form B - Osage Oil Mining Lease
Form C - Osage Oil and Gas Mining Lease
Form D - Osage Mining Leases Bond
Form E - Evidence of Authority of Officers to Execute Papers
Form F - Assignment of Lease Form
Form G - Osage Mining Leases Collective Bond

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