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 Southwestern Indian Polytechnic Institute (SIPI)	Form	Modified	Available
Application for admission to SIPI	Form	Modified	Repair queued
Application for Admission to Haskell Indian Nations University	Form	Modified	Available
Application for Admission to Haskell Indian Nations University	Form	Modified	Missing upstream
BIA-22 Privacy Act System of Record - Indian Student Records.pdf	Supplementary Document	Uploaded 2022-03-08	Available
30-Day Haskell 1076-0114.pdf	Supplementary Document	Uploaded 2021-03-26	Available
30-Day Haskell 1076-0114.pdf	Supplementary Document	Uploaded 2021-03-26	Available
2021 Supporting Statement 1076-0114 (App for Haskell and SIPI).docx	Supporting Statement A	Uploaded 2022-03-08	Available
2021 Supporting Statement 1076-0114 (App for Haskell and SIPI) - FINAL.docx	Supporting Statement A	Uploaded 2021-03-16	Repair queued
2020-Haskell and SIPI 60 day notice.pdf	Supplementary Document	Uploaded 2021-03-15	Available
2020-Haskell and SIPI 60 day notice.pdf	Supplementary Document	Uploaded 2021-03-15	Missing upstream
BIA-22 Privacy Act System of Record - Indian Student Records.pdf	Supplementary Document	Uploaded 2012-03-12	Available
BIA-22 Privacy Act System of Record - Indian Student Records.pdf	Supplementary Document	Uploaded 2012-03-12	Repair queued
Public Law 99_228.pdf	Supplementary Document	Uploaded 2008-12-03	Available
Public Law 99_228.pdf	Supplementary Document	Uploaded 2008-12-03	Repair queued
25 USCS 13.pdf	Supplementary Document	Uploaded 2008-10-22	Available
25 USCS 13.pdf	Supplementary Document	Uploaded 2008-10-22	Repair queued
Public Law 95_561.pdf	Supplementary Document	Uploaded 2008-10-21	Available
Public Law 95_561.pdf	Supplementary Document	Uploaded 2008-10-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187215	Application for admission to SIPI	Form	Modified	Application for Admission Southwestern Indian Polytechnic Institute (SIPI)
187215	Application for admission to SIPI	Form	Modified
187215	Application for admission to SIPI	Instruction	Modified
11490	Application for Admission to Haskell Indian Nations University	Form	Modified	Application for Admission to Haskell Indian Nations University
11490	Application for Admission to Haskell Indian Nations University	Form	Modified
11490	Application for Admission to Haskell Indian Nations University	Instruction	Modified

ICR Details

OMB Control No: 1076-0114	ICR Reference No: 202103-1076-004
Status: Active	Previous ICR Reference No: 201711-1076-001
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: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/09/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/26/2021
Terms of Clearance: OMB approves this information collection for 3 years, but with the request that DOI/BIA continue to work to make the entire application process available online. The public has requested the application be accepted through online submission and DOI/BIA should work to make both online and by mail to application available in order to meet the needs of their prospective students. At the next approval stage, progress toward online applications should clearly be explained in the supporting statement. In addition, OMB requests that DOI/BIA reevaluate the type of medical information/evaluation requested in the “Clinical Record – Report of Medical Examination of School Children” and develop a medical evaluation form and collection medical information that is appropriate for young adults entering college level education.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2025	36 Months From Approved	03/31/2022
Responses	2,100	0	4,000
Time Burden (Hours)	800	0	1,750
Cost Burden (Dollars)	11,155	0	10,000

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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.

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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
   Statute at Large: 99 Stat. 1747 Name of Statute: Blood Quantum Act
   Statute at Large: 48 Stat. 180 Name of Statute: Indian Appropriations of the 48th Congress
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 76100	11/27/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 16235	03/26/2021
Did the Agency receive public comments on this ICR? No

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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	Application for Admission to Haskell Indian Nations University
Application for admission to SIPI	n/a	Application for Admission Southwestern Indian Polytechnic Institute (SIPI)

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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	2,100	4,000	0	0	-1,900	0
Annual Time Burden (Hours)	800	1,750	0	0	-950	0
Annual Cost Burden (Dollars)	11,155	10,000	0	0	1,155	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:

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Annual Cost to Federal Government: $88,142

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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Common Form ICR:  No

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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: 03/26/2021

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