Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Electrical Power Service Application, 25 CFR 175	Form and Instruction	Modified	Repair queued
86 FR 50737.pdf	Supplementary Document	Uploaded 2022-09-26	Repair queued
87 FR 58369.pdf	Supplementary Document	Uploaded 2022-09-26	Repair queued
IAFR001125__Supporting Statement A (1076-0021)__09-2022.docx	Supporting Statement A	Uploaded 2022-09-19	Repair queued
86 FR 50156.pdf	Supplementary Document	Uploaded 2022-08-15	Repair queued
79 FR 24002.pdf	Supplementary Document	Uploaded 2022-08-15	Repair queued
25 CFR 175.pdf	Supplementary Document	Uploaded 2012-12-19	Repair queued
Debt Collection Improvement Act.pdf	Supplementary Document	Uploaded 2009-06-15	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43768	Electrical Power Service Application, 25 CFR 175	Form and Instruction	Modified
255987	Letter from medical services provider, 25 CFR 175		New

ICR Details

OMB Control No: 1076-0021	ICR Reference No: 202208-1076-002
Status: Active	Previous ICR Reference No: 201906-1076-007
Agency/Subagency: DOI/BIA	Agency Tracking No: IAFR001125
Title: Electrical Power Service Application, 25 CFR 175
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/07/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/26/2022
Terms of Clearance: Agency to continue exploring the possibility of allowing for electronic submission of information for this collection

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	36 Months From Approved	03/31/2023
Responses	1,315	0	1,300
Time Burden (Hours)	665	0	650
Cost Burden (Dollars)	0	0	0

---

Abstract: The BIA owns, operates, and maintains three electric power utilities that provide a service to the end user, pursuant to 25 CFR 175 (Indian Electric Power Utilities). The BIA must collect customer information to identify the individual responsible for repaying the government its costs for delivering the service and bill for those costs. The BIA must also collect information to identify the location of the service delivery (i.e., electrical hook-up). In addition, the Debt Collection Improvement Act of 1996 (DCIA), 31 U.S.C. 3701-3733 requires that certain information be collected from individuals and businesses doing business with the government. This information includes the taxpayer identification number for possible future use to recover delinquent debt.

---

Authorizing Statute(s): US Code: 31 USC 3701-3733 Name of Law: Debt Collection Improvement Act of 1996
  

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:
	86 FR 50737	09/10/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 58369	09/26/2022
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
Electrical Power Service Application, 25 CFR 175	N/A	Electric Service Application
Letter from medical services provider, 25 CFR 175

---

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	1,315	1,300	0	15	0	0
Annual Time Burden (Hours)	665	650	0	15	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: On page 2 of the “Electric Service Application” form, clarifying text regarding the option for a “Letter from medical services provider.” Customers that need essential medical equipment in their home to sustain life should obtain a letter from their medical services provider and contact respective utility. A letter on file from customer's medical services provider does not guarantee their service will not be disconnected for unpaid electric bills. Accounts with a letter on file from customer's medical services provider are subject to the same bill payment terms as other accounts.

---

Annual Cost to Federal Government: $5,750

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

---

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: 09/26/2022

---