Data Collection Sheet

OMB Control No. 1076-0161; Expiration: XX/XX/20XX

INDIAN RESERVATION ROADS FIELD DATA COLLECTION SHEET

(TO BE COMPLETED PER ROUTE AND SECTION)

(1) Region: (2) Agency: (3) Reservation: .

Route Name: (4) Route Number: .

(5) Section Number: .

(6) Class (circle the appropriate number)

1. Major Arterial 2. Rural Minor arterial 3. Streets located within communities

4. Rural Major Collector 5. Rural Local 6. City Minor Arterial Street

7. City Collector Streets 8. Non-Road projects such as trails and paths

(7)	Section Length (miles)	Bridge Information
(14)	Ownership (circle the appropriate number)	Section
	1. BIA 2. Tribe 3. State	Length
	4. Urban (City or Town) 5. County or Township	Width
(16) Terrain (circle the appropriate number)		Condition
	1. Flat 2. Rolling 3. Mountainous	Photo #
(17)	Roadbed Condition (circle the appropriate number)	Waypoint #
	1. Proposed Road	Township/Range
	2. Primitive Trail	Section
	3. Bladed unimproved road, poor drainage, poor alignment
	4. A designed and constructed roadbed with some drainage and alignment improvements required
	5. A roadbed constructed to the adequate standards with good horizontal and vertical alignment and proper drainage
	6. A roadbed constructed to adequate standards - curb and gutter on one side
	7. A roadbed constructed to adequate standards - curb and gutter on both sides
(18) Wearing Surface Condition (SCI) .
(19)	Surface Width (Feet)	Route Information
(20)	Surface Type (circle the appropriate number)	Township/Range
	0. Proposed roads not open to traffic	Sections
	1. Primitive
	2. Earth Road	Township/Range
	3. Gravel Surface	Sections
	4. A bituminous material less than 2" thick
	5. Bituminous material 2” thick or more	Photo #
	6. Concrete
(26)	Shoulder Width (Feet)	WayPoint Begin #
(27)	Shoulder Type (circle the appropriate number)	WayPoint End #
	1. Earth shoulder
	2. Stabilized shoulder gravel, asphalt treatment, etc
	3. Pave Shoulder
	4. Curb (urban type)

Paperwork Reduction Act Statement: The information collected herein is required to obtain or maintain a benefit. It is estimated that responding to the request will take an average of 40 hours to complete. This includes the amount of time it takes to review instructions, gather and maintain the data needed, and complete the form. In compliance with the Paperwork Reduction Act of 1995, as amended, this collection has been reviewed by the Office of Management and Budget and assigned the number and expiration date at the top right corner of the form. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless there is a valid OMB clearance number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Bureau of Indian Affairs, Division of Transportation, 1849 C Street, NW, MS-4141, Washington, D.C. 20240. Note: comments, names, addresses, phone numbers, e-mail addresses, or other personal identifying information of commenters may be made publicly available at any time. While commenters can ask to withhold personal identifying information from public review, the Department cannot guarantee that it will be able to do so.