Application for Admission to Haskell Indian Nations University and to Southwestern Indian Polytechnic Institute

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Application for admission to SIPI	Form and Instruction	Modified	Available
Application for Admission to Haskell Indian Nations University	Form and Instruction	Modified	Available
8-25-15.Renewal Agency IC_SIPI and Haskell Applications (30-day).pdf	Supplementary Document	Uploaded 2015-08-25	Available
Supporting Statement 1076-0114 (App for Haskell and SIPI) 8-19-15.docx	Supporting Statement A	Uploaded 2015-08-19	Available
4-23-15.Renewal Agency IC_Application to Haskell and SIPI (60-day).pdf	Supplementary Document	Uploaded 2015-07-22	Available
BIA-22 Privacy Act System of Record - Indian Student Records.pdf	Supplementary Document	Uploaded 2012-03-12	Available
Public Law 99_228.pdf	Supplementary Document	Uploaded 2008-12-03	Available
25 USCS 13.pdf	Supplementary Document	Uploaded 2008-10-22	Available
Public Law 95_561.pdf	Supplementary Document	Uploaded 2008-10-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187215	Application for admission to SIPI	Form and Instruction	Modified
11490	Application for Admission to Haskell Indian Nations University	Form and Instruction	Modified

ICR Details

OMB Control No: 1076-0114	ICR Reference No: 201507-1076-002
Status: Historical Active	Previous ICR Reference No: 201202-1076-003
Agency/Subagency: DOI/BIA	Agency Tracking No:
Title: Application for Admission to Haskell Indian Nations University and to Southwestern Indian Polytechnic Institute
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/02/2015
	Date Received in OIRA: 08/25/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2018	36 Months From Approved	10/31/2015
Responses	4,000	0	4,000
Time Burden (Hours)	2,000	0	2,000
Cost Burden (Dollars)	12,360	0	12,240

---

Abstract: These forms are used to collect information to determine eligibility of respondent for admission to post secondary education administered by the Bureau of Indian Education.

---

Authorizing Statute(s): PL: Pub.L. 95 - 561 1102 Name of Law: Education Amendments of 1978
   Statute at Large: 25 Stat. 13 Name of Statute: the Snyder Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 22739	04/23/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 51594	08/25/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Application for Admission to Haskell Indian Nations University	N/A	Haskell Application for Admission
Application for admission to SIPI	n/a	Application for Admission Southwestern Indian Polytechnic Institute (SIPI)

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	4,000	4,000	0	0	0	0
Annual Time Burden (Hours)	2,000	2,000	0	0	0	0
Annual Cost Burden (Dollars)	12,360	12,240	0	0	120	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $109,590

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/25/2015

---