Financial Assistance & Social Services Program, 25 CFR 20

Forms and Documents

Document Name	Status
Form 5-6602 Information for ISP Form and Instruction	New
Form 5-6601 Financial Assistance & Social Services Application Form and Instruction	Modified
25 CFR 20.rtf Supplementary Document	2010-09-20
03-22-11.Financial Assistance 30-Day.pdf Supplementary Document	2011-03-22
Justication for Revision FINAL.docx Supporting Statement A	2010-09-20
04-16-2010.Financial Assistance Revision 60-Day.pdf Supplementary Document	2010-08-11
SSAS PIA.pdf Supplementary Document	2008-07-24

IC Document Collections

IC ID	Document Title	Status
192898	Information for ISP Form and Instruction	New
11443	Financial Assistance & Social Services Application Form and Instruction	Modified

ICR Details

OMB Control No: 1076-0017	ICR Reference No: 200911-1076-001
Status: Historical Active	Previous ICR Reference No: 200805-1076-001
Agency/Subagency: DOI/BIA	Agency Tracking No:
Title: Financial Assistance & Social Services Program, 25 CFR 20
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/27/2011
	Date Received in OIRA: 03/22/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved	03/31/2012
Responses	335,000	0	200,000
Time Burden (Hours)	215,000	0	100,000
Cost Burden (Dollars)	0	0	0

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Abstract: The information is required by 25 CFR 20, The Financial Assistance and Social Services Program. 25 U.S.C. The Snyder Act authorizes providing welfare assistance and family community services to needy clients either through direct services, financial assistance grants or it may also be provided through Pub. L. 93-638. This revision will update the Application form, making it usable for all types of financial assistance and social services offered and will standardize the Individual Self-Sufficiency Plan.

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Authorizing Statute(s): US Code: 25 USC 13 Name of Law: Expenditures of appropriations by the Bureau
   PL: Pub.L. 93 - 638 5 ff Name of Law: Indian Self-Determination and Education Assistance
   PL: Pub.L. 102 - 477 3 ff Name of Law: Indian Employment, Training and Related Services Demonstration Act of 1992
   PL: Pub.L. 104 - 193 108ff Name of Law: Personal Responsibility and Work Opportunity Act
   Statute at Large: 111 Stat. 12 Name of Statute: Appropriations for BIA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 19986	04/16/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 15993	03/22/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Financial Assistance & Social Services Application	5-6601	Application for Financial Assistance and Social Services
Information for ISP	5-6602	Individual Self-Sufficiency (ISP) / Case Plan

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ICR Summary of Burden

	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	335,000	200,000	0	135,000	0	0
Annual Time Burden (Hours)	215,000	100,000	0	115,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: BIA is seeking approval for a revision to its application form to include all Financial Assistance and Social Service components and to make the form more user-friendly. This revision is requesting an increase of 115,000 hours. This increase results from: • An additional 40,000 respondents completing an application each year as a result of a program change due to agency discretion expanding the application to include all Financial Assistance and Social Services components, for an annual increase of 20,000 hours; and • The 95,000 respondents providing information for the newly standardized ISP, for an annual increase of 95,000 hours.

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Annual Cost to Federal Government: $24,009,900

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/22/2011

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