Information Collection

Financial Assistance & Social Services Program 25 CFR 20

IC 11443 under ICR 200805-1076-001 · OMB 1076-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0017 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BIA 5-6601 Financial Assistance & Social Services Program 25 CFR 20	Form and Instruction
BIA 5-6601 Social Services Application Form 2008, Social Service Application Form.doc	Form and Instruction

IC Title:

Financial Assistance & Social Services Program 25 CFR 20

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 25 CFR 20

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 and Instruction	BIA 5-6601	Social Services Application Form	2008, Social Service Application Form.doc		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 40 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200,000	0	200,000
Annual IC Time Burden (Hours)	100,000	50,000	50,000
Annual IC Cost Burden (Dollars)	0	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.