Information Collection

AIAN Tribal Enrollment

IC 219050 under ICR 201312-0607-004 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AI Screener AI Screener AIAN Tribal Enrollment	Form
Form AN Screener AN Screener AIAN Tribal Enrollment	Form
Form AI Moderator Guide AI Moderator Guide AIAN Tribal Enrollment	Form
Form AN Moderator Guide AN Moderator Guide AIAN Tribal Enrollment	Form
AI Screener AI Screener FG_Screener_Questions_AI L48 111915.docx	Form
AN Screener AN Screener FG_Screener_Questions_AN 111915.docx	Form
AI Moderator Guide AI Moderator Guide AIAN EQ Moderator Guide AI 112015.docx	Form
AN Moderator Guide AN Moderator Guide AIAN EQ Moderator Guide AN 112015.docx	Form
Focus Group Consent Form AIAN.docx Consent form	IC Document
Craigslist Ads + Recruitment Flyers + Tribal Publication Ads.docx Advertisements	IC Document
AIAN TEQ Research OMB Letter 111915.docx Memo	IC Document

IC Title:

AIAN Tribal Enrollment

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 13 CFR 141, 193 (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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AI Screener	AI Screener	FG_Screener_Questions_AI L48 111915.docx	Yes	Yes	Paper Only
Form	AN Screener	AN Screener	FG_Screener_Questions_AN 111915.docx	Yes	Yes	Paper Only
Form	AI Moderator Guide	AI Moderator Guide	AIAN EQ Moderator Guide AI 112015.docx	Yes	Yes	Paper Only
Form	AN Moderator Guide	AN Moderator Guide	AIAN EQ Moderator Guide AN 112015.docx	Yes	Yes	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 88

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	88	88
Annual IC Time Burden (Hours)	231	231
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent form	Focus Group Consent Form AIAN.docx	11/20/2015
Advertisements	Craigslist Ads + Recruitment Flyers + Tribal Publication Ads.docx	11/20/2015
Memo	AIAN TEQ Research OMB Letter 111915.docx	11/24/2015

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