Financial Assistance & Social Services Program, 25 CFR 20

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 5-6602 Information for ISP	Form and Instruction	Unchanged	Available
Form 5-6601 Financial Assistance & Social Services Application	Form and Instruction	Unchanged	Available
06-29-17.Agency IC FASS 30-day.pdf	Supplementary Document	Uploaded 2017-06-29	Available
2017 OMB# 1076-0017 FASS Support Statement.doc	Supporting Statement A	Uploaded 2017-06-13	Available
04-06-17.Renewal of Agency IC for Financial Assistance and Social Services.pdf	Supplementary Document	Uploaded 2017-06-02	Available
25 CFR 20.rtf	Supplementary Document	Uploaded 2010-09-20	Available
SSAS PIA.pdf	Supplementary Document	Uploaded 2008-07-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192898	Information for ISP	Form and Instruction	Unchanged
11443	Financial Assistance & Social Services Application	Form and Instruction	Unchanged

ICR Details

OMB Control No: 1076-0017	ICR Reference No: 201705-1076-003
Status: Active	Previous ICR Reference No: 201403-1076-003
Agency/Subagency: DOI/BIA	Agency Tracking No:
Title: Financial Assistance & Social Services Program, 25 CFR 20
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: 08/11/2017
	Date Received in OIRA: 06/29/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2020	36 Months From Approved	08/31/2017
Responses	335,000	0	335,000
Time Burden (Hours)	215,000	0	215,000
Cost Burden (Dollars)	0	0	0

---

Abstract: The information is required by 25 CFR 20, The Financial Assistance and Social Services Program. 25 U.S.C. The Snyder Act authorizes providing welfare assistance and family community services to needy clients either through direct services, financial assistance grants or it may also be provided through Pub. L. 93-638. This revision will update the Application form, making it usable for all types of financial assistance and social services offered and will standardize the Individual Self-Sufficiency Plan.

---

Authorizing Statute(s): US Code: 25 USC 13 Name of Law: Expenditures of appropriations by the Bureau
   US Code: 25 USC 3401, et seq Name of Law: Indian Employment, Training and Related Services Demonstration Act
   PL: Pub.L. 104 - 193 108ff Name of Law: Personal Responsibility and Work Opportunity Act
   Statute at Large: 111 Stat. 12 Name of Statute: Appropriations for BIA
   US Code: 25 USC 450 Name of Law: Indian Self-Determination and Education Assistance 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:
	82 FR 16853	04/06/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 29580	06/29/2017
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
Financial Assistance & Social Services Application	5-6601	Application for Financial Assistance and Social Services
Information for ISP	5-6602	Individual Self-Sufficiency (ISP) / Case Plan

---

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	335,000	335,000	0	0	0	0
Annual Time Burden (Hours)	215,000	215,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	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: $28,541,300

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: 06/29/2017

---