Application for Relocation Benefits

Documents and Forms

Document Name Document Type
Form MM1110.9 Application for Relocation Benefits Form and Instruction
MM1110.9 Application for Relocation Benefits - Navajo Application for Rel Ben_Navajo_ONHIR_20100115.docx Form and Instruction
MM-1110.10 Application for Relocation Benefits - Hopi Application for Rel Ben_Hopi_ONHIR_20100115.docx Form and Instruction
60Day FRN_E924932_ONHIR_20091016.pdf 60-Day Federal Register Notice IC Document
30Day FRN_ONHIR_20100115.docx Draft 30-Day Federal Register Notice IC Document
statutory authority_ONHIR_20100115.docx ONHIR Statutory Authority-25USC 640d(11-14) IC Document
Supporting Stmt_ONHIR_20100115.docx Supporting Statement to OMB 83-I IC Document
OMB83-I_ONHIR_20100125.pdf OMB Form 83-I, Paperwork Reduction Act Submission IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Relocation Benefits	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 640d(11-14) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	MM1110.9	Application for Relocation Benefits - Navajo	Application for Rel Ben_Navajo_ONHIR_20100115.docx		No		Fillable Printable
Form and Instruction	MM-1110.10	Application for Relocation Benefits - Hopi	Application for Rel Ben_Hopi_ONHIR_20100115.docx		No		Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title: ONHIR Applications for Relocation Benefits	FR Citation: 45 FR 224

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
60-Day Federal Register Notice	60Day FRN_E924932_ONHIR_20091016.pdf	02/01/2010
Draft 30-Day Federal Register Notice	30Day FRN_ONHIR_20100115.docx	02/01/2010
ONHIR Statutory Authority-25USC 640d(11-14)	statutory authority_ONHIR_20100115.docx	02/01/2010
Supporting Statement to OMB 83-I	Supporting Stmt_ONHIR_20100115.docx	02/01/2010
OMB Form 83-I, Paperwork Reduction Act Submission	OMB83-I_ONHIR_20100125.pdf	02/01/2010

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