Indian Affairs Specific Forms and Guidance

Logistics Service/Transfer of Equipment Request

This is a combined form that should be used when requesting any services from the Indian Affairs Logistics Office or when requesting any piece of equipment or sensitive minor item with an Indian Affairs/DOI Inventory Tag be moved from one location to another.

Mortgage HB Attachment 10: Leasehold Certificate of Approval

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 11: Leasehold Disapproval Decision Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 12: Leasehold Lender Transmittal Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 13: Trust Land Mortgage Loan Checklist

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 14: Land Mortgage Acknowledgement Incomplete Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 15: Land Mortgage Agency Transmittal Memorandum

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 16: Trust Land Mortgage Commitment to Approve Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 17: BIA Disclosure Statement

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 18: Land Mortgage Certificate of Approval

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 19: Land Mortgage Disapproval Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 20: Land Mortgage Lender Transmittal Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 21: RD Recommendation Memorandum

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 22: Land Mortgage Lender Loan Checklist

See the IA Paperwork Reduction Act (PRA) tab for this form. This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 2: Leasehold Mortgage Lender Checklist

See the IA Paperwork Reduction Act (PRA) tab for this form. This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 3: Leasehold Mortgage Loan Checklist

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 4: Leasehold Acknowledgement Incomplete Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 5: Leasehold Acknowledgement Complete Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 6: Leasehold ROW Acknowledgement Complete Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 7: NEPA Cat Ex Checklist

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 8: Superintendent Recommendation Memorandum

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Mortgage HB Attachment 9: Leasehold Approved Decision Letter

This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)

Motor Vehicle Operator Report

[Note: This document is for IA Internal Use Only] This form is used by Safety Managers as detailed in 25 IAM 4 and 25 IAM 4-H.

New Contractor or Volunteer - IA Onboarding Checklist

[Note: This form is for IA Internal Use Only] This form is to be used as a checklist to facilitate access to the correct systems, etc. for new contractors or volunteers, as needed.

New IA (Federal) Employee - IA Onboarding Checklist

[Note: This form is for IA Internal Use Only] This form is to be used as a checklist to facilitate access to the correct systems, etc. for new Indian Affairs employees.

Notice of Designation (BIA 4285)

IA Accounting Operations form

Notice of Hazard

[Note: This document is for IA Internal Use Only] This is the notice the IA Inspector issues for a RAC 1 or RAC 2 deficiency. For more information, see 25 IAM 3-H, Volume 4.

Notice of Hazard Identification Report

[Note: This form is for IA Internal Use Only] This form is used to track and report on the Notice of Hazard form(s) issued.

Notice of Project Completion

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

Obligation in Expired Fund Request Form

This form is intended for use when requesting an FBMS override to record an obligation in an expired fund

Occupational Safety and Health Program Evaluation Corrective Action Plan

[Note: This form is for IA Internal Use Only] This is a Word form used by the Division of Safety & Risk Management (see 25 IAM 3) (please open using Chrome due to issues with IE and Excel/Word docs.)

Occupational Safety and Health Training Report

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

OSHA Notice and/or Site Visit Quarterly Report

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

Petition for Partition

Form used by the Pacific Region

Priority Calculation Form - Manual Entry

Form used as part of the Housing Improvement Program (HIP); this form is to be used if applicant information must be calculated and entered into the TAPR form manually

Property Damage from Accidental Causes

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

Request for Additional Funds (RAF)

Welfare Assistance program form

Request for Final Inspection/Re-inspection and Certificate of Occupancy

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

Request RACA to Schedule a Zoom Session(s)

[Note: This form is for IA/DOI Internal Use Only] This is a Word form that should be used by a DOI program/office to request RACA’s assistance with scheduling a Zoom session(s) for a planned consultation/listening session (please open using Chrome due to issues with IE and Excel/Word docs.)

Revocation of Designation (BIA 4286)

IA Accounting Operations form

ROW: 60-day Notice of Intent for BIA Approval without Consent of Landowner(s) Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Administrative Modification Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Amendment Acknowledgment Letter

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Applicant's Letter of Intent (LOI) Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Applicant's Request to Amend Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Assignment Acknowledgment Letter

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Assignment of ROW Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Assignment/Amendment Decision Letter Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: BIA Approval without Consent of Landowners

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: BIA Consent of Behalf of Non Compos Mentis

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: BIA Consent on Behalf of Deceased Landowner(s)

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: BIA Consent on Behalf of Orphaned Minors

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: BIA Consent on Behalf of the POA

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: BIA Consent on Behalf of Whereabouts Unknown

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: BIA's Reply Letter Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Cancellation/Termination of Easement Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Consent of Owner for Renewal/Assignment/Amendment/Mortgage of Existing ROW Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Consent of Owner to Grant a ROW Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Grant of Easement Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Letter for a Complete ROW Application

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Letter for an Incomplete ROW Application

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Notice of an Extension

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Notice of Decision to Applicant

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Notice of Decision to Landowner(s)

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Permission to Overlap on ROW Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: Rights-of-Way Checklist

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

ROW: ROW Amendment Template

Form/checklist/template for use as documented in the Rights-of-Way (ROW) Handbook (52 IAM 9-H).

Safety and Health Action Plan Report

[Note: This form is for IA Internal Use Only] This is a Word form used by the Division of Safety & Risk Management (see 25 IAM 3) (please open using Chrome due to issues with IE and Excel/Word docs.)

Safety and Heath Action Plan Status Report

[Note: This form is for IA Internal Use Only] This is a Word form used by the Division of Safety & Risk Management (see 25 IAM 3) (please open using Chrome due to issues with IE and Excel/Word docs.)

Sample Affidavits for Corrective Deeds and Affidavits

[Note: This form is for IA Internal Use Only] The Sample Affidavits are to be used as part of the 52 IAM 7: Corrective Deeds and Affidavits policy.

Satisfaction of HIP Grant Agreement (Sample)

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

Schedule of Collection

Serious Incident Report (Emergency Management Briefing Report)

[Note: This form is for IA Internal Use Only] This is a Word template to be used as indicated in 92 IAM 1: Overview (Emergency Management) to report a serious incident (please open using Chrome due to issues with IE and Excel/Word docs.)

Space Worksheet and Summary spreadsheets

Space Management

Tort Claim Payments and Third Party Recoveries

[Note: This form is for IA Internal Use Only] This form is used by the Division of Safety & Risk Management (see 25 IAM 5 and 25 IAM 5-H).