Information Collection

1000.173 - Request to negotiate a FA

IC 190036 under ICR 201206-1076-004 · OMB 1076-0143.

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IC Title:

1000.173 - Request to negotiate a FA

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 25 CFR 1000.173

Information Collection Instruments:

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Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5	-5	10
Annual IC Time Burden (Hours)	15	-15	30
Annual IC Cost Burden (Dollars)	100	0	100

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