Application for Relocation Benefits

Forms and Documents

Document Name	Status
Form MM1110.9 Application for Relocation Benefits Form and Instruction	New
30-Day FRN_ONHIR_75389001.pdf Supplementary Document	2010-03-02
SORN_ONHIR Applications_100125.pdf Supplementary Document	2010-03-02
60Day FRN_E924932_ONHIR_20091016.pdf Supplementary Document	2010-02-01
OMB83-I_ONHIR_20100125.pdf Supplementary Document	2010-02-01
statutory authority_ONHIR_20100115.docx Supplementary Document	2010-02-01
Supporting Stmt_ONHIR_20100115.docx Supporting Statement A	2010-02-01

IC Document Collections

IC ID	Document Title	Status
191909	Application for Relocation Benefits Form and Instruction	New

ICR Details

OMB Control No: 3148-0001	ICR Reference No: 201002-3148-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: ONHIR	Agency Tracking No:
Title: Application for Relocation Benefits
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/13/2010
	Date Received in OIRA: 03/02/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2013	36 Months From Approved
Responses	500	0	0
Time Burden (Hours)	250	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Office of Navajo and Hopi Indian Relocation (ONHIR) uses the information collected from Navajo and Hopi individuals and households on their applications for relocation benefits to determine their eligibility to receive such benefits under the Navajo-Hopi Settlement Act of 1974, as amended.

---

Authorizing Statute(s): US Code: 25 USC 640d(11-14) Name of Law: Navajo-Hopi Settlement Act of 1974, as amended
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 199	10/16/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 9001	02/26/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Relocation Benefits	MM-1110.10, MM1110.9	Application for Relocation Benefits - Navajo ,   Application for Relocation Benefits - Hopi

---

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	500	0	0	500	0	0
Annual Time Burden (Hours)	250	0	0	250	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: This is a collection of information in use without an OMB Control Number.

---

Annual Cost to Federal Government: $230,000

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

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

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 03/02/2010

---