Document
OMB # 1076-0141
ICR 201210-1076-002 · OMB 1076-0141 · Object 35620001.
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Document Metadata
| File Type | application/msword |
|---|---|
| File Title | OMB # 1076-0141 |
| Author | Indian Affairs User |
| Last Modified By | Writer |
| File Modified | 2012-12-18 |
| File Created | 2026-07-14 |
| Conversion State | complete |
Extracted Text
OMB # 1076-0141 Expires: XX-XX-XXXX WATER REQUEST (AGENCY NAME) (NAME) IRRIGATION PROJECT (CITY, STATE) REQUESTER’S NAME: ____________________________________________________________________________ DATE OF REQUEST: ___________________________ TIME OF REQUEST: ____________________________ UNIT NO.: _____________________________ SERIAL NO.: __________________________________________ LEGAL DESCRIPTION: __________________________________________ CANAL / LATERAL: __________________________ HEAD GATE: __________________________________ NUMBER OF ACRES TO IRRIGATE: ______________ TYPE OF CROP GROWN: __________________________________________________________________________ DIVERSION AMOUNT REQUESTED: _________________________________ TIME ON: _____________________________ DATE: _________________________ TIME OFF: _____________________________ DATE: _________________________ DITCH RIDER NAME: REQUEST must be in at least 72 hours and not over 7 days prior to desired time of water delivery. WATER USERS must be responsible for water until returned to canal. Use one request for each turnout. Paperwork Reduction Statement: This information is being collected to determine the consumer’s water needs and it will be used to determine when and where to deliver water. Response to this request is required to obtain irrigation water. Public reporting burden for this form is estimated to average 30 minutes per response. Direct comments regarding the burden estimate or any other aspect of this form to Attn: Information Collection Clearance Officer – Indian Affairs, 1849 C Street, NW, MS-4141, Washington, DC 20240. Note: comments, names and addresses of commentators is available for public review during regular business hours. If you wish us to withhold this information you must state this prominently at the beginning of your comment. We will honor your request to the extent allowable by law. A federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The number and expiration date are displayed in the upper right corner of the form.