Information Collection

Electrical Power Service Application, 25 CFR 175

IC 43768 under ICR 202208-1076-002 · OMB 1076-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0021 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Electrical Power Service Application, 25 CFR 175	Form and Instruction
Electric Service Application 1076-0021 Application for Electrical Service 08-31-2022.pdf www.bia.gov/policy-forms/online-forms	Form and Instruction
Electric Service Application 1076-0021 Application for Electrical Service 08-31-2022.pdf www.bia.gov/policy-forms/online-forms	Form and Instruction

IC Title:

Electrical Power Service Application, 25 CFR 175

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 25 CFR 175

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 and Instruction	N/A	Electric Service Application	1076-0021 Application for Electrical Service 08-31-2022.pdf	https://www.bia.gov/policy-forms/online-forms	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Supply

Privacy Act System of Records

Title: BIA-26--Indian Electric Power Utilities

FR Citation: 52 FR 43401

Number of Respondents: 1,300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,300	1,300
Annual IC Time Burden (Hours)	650	650
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.