OMB# 1076-0160, Verification of Indian Preference for Employment
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.
Version 1 (Old Forms)
IA 7702 - Statistical Report (Used PRIOR to 2003)
IA 7702 - Statistical Report and Instructions (Currently in Use)
Version 2 (New Forms)
477 Financial Report Form and Instructions
477 Statistical Report and Instructions
Guidance - P.L. 102-477 Financial Reporting Functional Cost Categories
Reporting System for P.L. 102-477 Demonstration Project
To ensure a smooth transition from the older version (Version 1) to the new version (Version 2),
BIA will continue to accept both versions until February 28, 2018.
Version 1 Forms remain available for use until February 2018 to provide flexibility to tribes who may have
existing P.L. 102-477 contracts prior to February 28, 2015.
NOTE: Version 1 Forms will be obsolete starting February 28, 2018 and will be replaced by Version 2 Forms.
Version 2 Forms are available for use for Tribes who have entered into a new P.L. 102-477 contract on or after March 1, 2015.
Form 5-5243 - Performance Bond
Form 5-5514 - Bid for Grazing Privileges
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
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.
Housing Improvement Program (HIP) Housing Assistance Application and Instructions