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Indian Affairs Specific Forms and Guidance

//FERMIN TEST

Forms and Guidance

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)

Title Description
Accounts Payable (AP) Return of Funds Form

[Note: This form is for IA Internal Use Only] Please use this form for Return of Funds originating from an Accounts Payable or ASAP Payment Transactions

Application for Restoration of Annual Leave

[Note: This form is for IA Internal Use Only] Request to restore annual leave

BIA 4287 - Request for Relief of Collection Officer

Used for requesting relief on behalf of a Collection Officer when a loss has been incurred. Instructions are also included.

BIA 4311 - Receiving Report

[Note: This form is for IA Internal Use Only]

BIA 4314 - Requisition

[Note: This form is for IA Internal Use Only] This form is for purchases up to the micropurchase threshold; all other purchases should use the "BIA/BIE Electronic Purchase Request (EPR) Form".

BIA 4335 - Donation of Personal Property to Indian Tribes or Tribal Organizations

[Note: This form is for IA Internal Use Only] This form is used by the Division of Property Management.

BIA 4432 - Verification of Indian Preference for Employment

See the IA Paperwork Reduction Act (PRA) tab for this form

BIA/BIE Electronic Purchase Request (EPR) Form

[Note: This form is for IA Internal Use Only] If the FBMS approval will not be completed by the direct program supervisor, this form must be completed by the requesting program or school and signed by the cost center supervisor (at a minimum). See 22 IAM 3 for additional details.

BIA/BIE eQIP Request Form

[Note: This form is for IA Internal Use Only] Form created by the Office of Human Capital Management

BIE 504 Consent for Initial Evaluation/Receipt of 504 Rights and Procedural Safeguards

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

BIE 504 Rights and Procedural Safeguards

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

BIE Consent to Review Evaluative Information

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

BIE Invitation to 504 Meeting

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

BIE Section 504 Checklist

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

BIE Section 504 Identification Determination Summary

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

BIE Section 504 Manifestation Determination

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

BIE Section 504 Meeting Parent Input

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

BIE Section 504 Plan

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

BIE Section 504 Teacher Input

BIE uses this form to implement 30 IAM 15: Section 504 of the Rehabilitation Act of 1973.

Buy Indian Act Deviation Form

[Note: This form is for IA Internal Use Only] This form is to be used to document/justify acquisitions that deviate from the Buy Indian Act.

Capitalized ABZON Request Form

[Note: This form is for IA Internal Use Only]

Carryover Appeal Request Form

[Note: This form is for IA Internal Use Only] This form is used to submit a carryover funding request to the DAS-M

Categorical Exclusion Exception Review (CEER) Checklist

[Note: This form is for IA Internal Use Only] Checklist that can be used to facilitate compliance with the National Environmental Policy Act (NEPA); also used as part of the Housing Improvement Program (HIP)

CDIB Form

See the IA Paperwork Reduction Act (PRA) tab for this form

Certification of Final Inspection

Form used as part of the Housing Improvement Program (HIP)

Certification of Permanently Corrected Deficiencies

[Note: This form is for IA Internal Use Only] This is a Word form used by the Division of Safety and Risk Management (please open using Chrome due to issues with IE and Excel/Word docs.)

Certification of Preliminary Site Evaluation

Form used as part of the Housing Improvement Program (HIP)

Checklist for HIP Applications

Form used as part of the Housing Improvement Program (HIP)

Deed Form - AIPRA

Form used by the Pacific Region

Deed Form - Special
Deed Form - Standard

Form used by the Pacific Region

Environmental and Disposal Liability Location of Concern (LOC) Notification Form
Equipment Operation Data Form

(Formerly DI-120) Division of Property Excel form used by programs to document monthly fleet utilization (note: please open using Chrome due to issues with IE and Excel/Word docs.)

Equipment Operation Data Form

[Note: This form is for IA Internal Use Only] This form is used by the Division of Property Management (Excel) (note: please open using Chrome due to issues with IE and Excel/Word docs.)

Exit Clearance Form

[Note: This form is for IA Internal Use Only] This (Word) form applies to ASIA, BIA, and BIE (note: please open using Chrome due to issues with IE and Excel/Word docs.)

FBMS FED Form - Excel Form

Excel upload file (note: please open using Chrome due to issues with IE and Excel/Word docs.)

FBMS FED Form and Instructions

Data entry form and instructions

Federal Register documents: DOI Briefing Paper Template

[Note: This form is for IA Internal Use Only] Template (Word) used to obtain Departmental clearance for Federal Register documents (please open using Chrome due to issues with IE and Excel/Word docs.)

Federal Register documents: Formatting Checklist

[Note: This form is for IA Internal Use Only] Checklist

Financial Assistance and Social Services Report (FASSR)

Welfare Assistance program form (Excel) (note: please open using Chrome due to issues with IE and Excel/Word docs.)

Fire Damage Report

[Note: This form is for IA Internal Use Only] This form is used by the Division of Safety & Risk Management.

Fire Loss Report

[Note: This form is for IA Internal Use Only] This form is used by the Division of Safety & Risk Management (it is related to 25 IAM 8: Fire Safety Program).

Forestry: (BIA 5-5323) Contract Part B Standard Provisions

Forestry & Wildland Fire Management form

Forestry: (BIA 5-5324) Estimated Volume Contract - Part A

Forestry & Wildland Fire Management form (Word) (note: please open using Chrome due to issues with IE and Excel/Word docs.)

Forestry: (BIA 5-5326) Estimated Volume Contract - Allotment Supplementary Agreement

Forestry & Wildland Fire Management form (Word) (note: please open using Chrome due to issues with IE and Excel/Word docs.)

Forestry: (BIA 5-5327) Predetermined Volume Contract - Part A

Forestry & Wildland Fire Management form (Word) (note: please open using Chrome due to issues with IE and Excel/Word docs.)

Forestry: (BIA 5-5328) Sole Owner Allotment Harvest Permit

Forestry & Wildland Fire Management form (Word) (note: please open using Chrome due to issues with IE and Excel/Word docs.)

Forestry: (BIA 5-5331) Timber Harvest Permit

Forestry & Wildland Fire Management form (Word) (note: please open using Chrome due to issues with IE and Excel/Word docs.)

Forestry: (BIA 5-5332) Non-Timber Forest Products Harvest Permit

Forestry & Wildland Fire Management form (Word) (note: please open using Chrome due to issues with IE and Excel/Word docs.)

General Purpose Receipt (BIA 5-777)

IA Accounting Operations form

HIP - Authorization to Release Information

Form used as part of the Housing Improvement Program (HIP)

HIP - Grant Agreement (Sample)

Form used as part of the Housing Improvement Program (HIP)

HR - IA Compressed Work Schedule Agreement

[Note: This form is for IA Internal Use Only] Request for Compressed work schedule

HR - IA Fitness Membership Fee Reimbursement - Self-Certification of Usage Form

See 28 IAM 11: Fitness Membership Fee Reimbursement policy for more information on this form.

HR - IA Fitness Membership Fee Reimbursement Program - Report of Taxable Fringe Benefit Form

See 28 IAM 11: Fitness Membership Fee Reimbursement policy for more information on this form.

HR - IA Fitness Membership Fee Reimbursement Program Application

Employees must use this form to apply to participate in IA's fitness center fee reimbursement program. See 28 IAM 11: Fitness Membership Fee Reimbursement policy for more information.

HR - IA Flexitime (Gliding Schedule) Work Schedule Agreement

[Note: This form is for IA Internal Use Only] Request for Flexitime work schedule

HR - IA Maxiflex Work Schedule Agreement

[Note: This form is for IA Internal Use Only] Request for Maxiflex work schedule

HR - Remote Work Agreement

This form should be completed once an employee's Remote Work Request has been approved.

HR - Remote Work Request Form

This form should be used by Indian Affairs employees who would like to begin the process for requesting the remote work option.

IA Annual Incidental Motor Vehicle Operator's Certification

[Note: This document is for IA Internal Use Only] This certification statement is completed annually by incidental motor vehicle operators (see 25 IAM 4 for more details).

IA Fire Protection and Life Safety Systems Inspection, Testing, and Maintenance Guidelines

[Note: This form is for IA Internal Use Only] This guidance is used by the Division of Safety & Risk Management (it is related to 25 IAM 8: Fire Safety Program).

IA Motor Vehicle Operator Authorization Card

[Note: This document is for IA Internal Use Only] This is the template used by the Division of Safety and Risk Management to issue Motor Vehicle Operator Authorization cards

IIM Accounts: Assessment and Evaluation Form

This form is used as part of the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.

IIM Accounts: Assessment Request - Outside of Service Area Procedures

This guidance is related to the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.

IIM Accounts: Distribution Plan Form

This form is used as part of the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.

IIM Accounts: Major Purchase Request Worksheet

This form is used as part of the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.

IIM Accounts: Six Month Case File Review Form

This form is used as part of the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.

Impaired Fire Protection Systems Report

[Note: This form is for IA Internal Use Only] This form is used by the Division of Safety & Risk Management.

Indian Affairs Harassing Conduct Allegation Intake Form

[Note: This form is for IA Internal Use Only] This form should be used by all IA officials to record a report of harassing conduct.

Indian Affairs Technology Waiver Request Form

[Note: This form is for IA Internal Use Only] The Indian Affairs Technology Waiver Request Form is used for requesting a waiver for unapproved or non-standard technology. Employees can find additional details about the process by accessing the Configuration Management Asset Management SharePoint site here.

Job Hazard Analysis (JHA) form

[Note: This form is for IA Internal Use Only] This form is used by the Division of Safety & Risk Management.

Justification for Space

[Note: This form is for IA Internal Use Only] Space Management

Land Description Review Worksheet
Land Description Review-Realty Form: Land Description Examination and Validation (LDEV) Request

BIA uses this form to implement NPM-TRUS-43 A1: Modernize the Land Description Review Process for Fee-to-Trust Acquisitions - Amendment 1

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