Tribal Enrollment Count

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0197 can be found here:

Documents and Forms

Document Name Document Type
Tribal Enrollment Count Form
R2 Enrollment Collection Form instructions_FINAL.docx Instruction
Tribal Enrollment Data Collection Enrollment Collection Form - fillable -v1.2.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Tribal Enrollment Count	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form	N/A	Tribal Enrollment Data Collection	Enrollment Collection Form - fillable -v1.2.pdf		Yes	Yes	Fillable Fileable Signable
Instruction			R2 Enrollment Collection Form instructions_FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 574	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	574	574
Annual IC Time Burden (Hours)	574	574
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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