Information Collection

Tribal Council Coverage Agreement

IC 235112 under ICR 201911-0960-002 · OMB 0960-0812.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0812 can be found here:

Documents and Forms

Document Name Document Type
Indian Tribal Council Coverage Agreement (revised).pdf Other-Indian Tribal Council Coverage
Indian Tribal Council Coverage Agreement (current).pdf Indian Tribal Council Coverage Agreement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Tribal Council Coverage Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Indian Tribal Council Coverage Agreement			Indian Tribal Council Coverage Agreement (revised).pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Indian Tribal Council Coverage Agreement	Indian Tribal Council Coverage Agreement (current).pdf	11/05/2019

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