NATIVE AMERICAN INTERN PROGRAM APPLICATION FORM

ICR 197711-3206-002

OMB: 3206-0081

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
176692 Migrated
ICR Details
3206-0081 197711-3206-002
Historical Active 197707-3206-001
OPM
NATIVE AMERICAN INTERN PROGRAM APPLICATION FORM
No material or nonsubstantive change to a currently approved collection   No
Emergency 11/14/1977
Approved with change 11/14/1977
Retrieve Notice of Action (NOA) 11/14/1977
  Inventory as of this Action Requested Previously Approved
10/31/1982 10/31/1982 07/31/1982
200 0 50
100 0 25
0 0 0

USED BY FOUR OF OUR REGIONS (NW, RM, SW, AND WE) IN MAKING THE SELECTION OF PARTICIPANTS IN THE INDIAN INTERN PROGRAM. THIS INTERN PROGRAM IS FINANCED BY THE DEPARTMENTS OF INTERIOR AND HEALTH AND HUMAN SERVICES, AS PART OF THEIR ANNUAL INTERAGENCY AGREEMENTS WITH THESE FOUR REGIONS.

None
None


No

1
IC Title Form No. Form Name
NATIVE AMERICAN INTERN PROGRAM APPLICATION FORM CSC-1305

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 200 50 0 0 150 0
Annual Time Burden (Hours) 100 25 0 0 75 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
11/14/1977


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