Information Collection

Tribal Enrollment Count

IC 246265 under ICR 202103-1076-005 · OMB 1076-0197.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.