Information Collection

request for loan guaranty, insurance and/or interest subsidy

IC 178443 under ICR 200611-1076-003 · OMB 1076-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0020 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5-4755 request for loan guaranty, insurance and/or interest subsidy	Form
5-4755 Request to BIA for Loan Guaranty, Loan Insurance, and/or 0K5-4755REQUESTforLOANGUARANTYINSURANCEInterestSubsidy11.9.pdf	Form

IC Title:

request for loan guaranty, insurance and/or interest subsidy

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 25 CFR 103.13 25 CFR 103.14 25 CFR 103.12 25 CFR 103.21

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5-4755	Request to BIA for Loan Guaranty, Loan Insurance, and/or Interest Subsidy	0K5-4755REQUESTforLOANGUARANTYINSURANCEInterestSubsidy11.9.pdf		No		Paper Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 65

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	130	130
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.