Information Collection

Application for Relocation Benefits

IC 191909 under ICR 201002-3148-001 · OMB 3148-0001.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.