Notice of Appointment of Counsel for an Indigent Indian

OMB Control No. 1076-0111

Expiration Date XX/XX/XX

INSTRUCTIONs

Notice of Appointment of Counsel

for an Indigent Indian Parent/custodian

Please complete the attached “Notice of Appointment of Counsel for an Indigent Indian Parent/Custodian” form if counsel for an indigent Indian parent/custodian has been appointed in an involuntary Indian child custody proceeding pursuant to 25 U.S.C. § 1912(b), and state law makes no provision for appointment of counsel in such proceedings. The form should be signed by the state court judge presiding over the involuntary child custody proceeding and sent to the appropriate Bureau of Indian Affairs (“BIA”) Regional Director listed below:

Regional Office	List of Tribes Served by Indian Affairs
Alaska Region Regional Office 3601 C Street Suite 1200 Anchorage , AK 99503-5947	https://www.bia.gov/regional-offices/alaska/tribes-served
Eastern Region 545 Marriott Drive Suite 700 Nashville , TN 37214	https://www.bia.gov/regional-offices/eastern/tribes-served
Eastern Oklahoma Region P.O. Box 8002 Muskogee, OK 74402-8002	https://www.bia.gov/regional-offices/eastern-oklahoma/tribes-served
Great Plains Region 115 4th Avenue Southeast Suite 400 Aberdeen , SD 57401	https://www.bia.gov/regional-offices/great-plains/tribes-served
Midwest Region Norman Pointe II Building 5600 W. American Blvd., Suite 500 Bloomington, MN 55437	https://www.bia.gov/regional-offices/midwest/tribes-served
Navajo Region P.O. Box 1060 Gallup, NM 87305	https://www.bia.gov/regional-offices/navajo/tribes-served
Northwest Region 911 Northeast 11th Avenue Portland, Oregon 97232-4169	https://www.bia.gov/regional-offices/northwest/tribes-served
Pacific Region 2800 Cottage Way Sacramento, CA 95825	https://www.bia.gov/regional-offices/pacific/tribes-served
Rocky Mountain Region 2021 4th Avenue North Billings, MT 59101	https://www.bia.gov/regional-offices/rocky-mountain/tribes-served
Southern Plains Region P.O. Box 368 Anadarko, OK 73005	https://www.bia.gov/regional-offices/southern-plains/tribes-served
Southwest Region 1001 Indian School Road, NW Albuquerque, NM 87104	https://www.bia.gov/regional-offices/southwest/tribes-served
Western Region 2600 N. Central Avenue, 4th Floor Mailroom Phoenix, AZ 85001	https://www.bia.gov/regional-offices/western/tribes-served

Please be advised that submission of the form does not guarantee payment of attorney fees and expenses by the BIA. The BIA must first certify that the indigent Indian parent/custodian is eligible to have his or her appointed counsel compensated by the BIA, and may deny certification for any of the reasons stated in 25 C.F.R. § 23.13(b).

Within ten (10) days of receiving a completed form, the BIA Regional Director will notify the court, the client, and the attorney in writing whether the indigent Indian parent/custodian has been certified as eligible to have his or her attorney fees and expenses paid by the BIA. The BIA Regional Director’s failure to respond within this 10-day period shall be deemed a denial of eligibility pursuant to 25 C.F.R. § 23.13(g).

The BIA Regional Director’s denial of an indigent Indian parent/custodian’s eligibility to have his or her attorney fees and expenses paid by the BIA may be appealed to the Assistant Secretary – Indian Affairs in accordance with the procedures set out in 25 C.F.R. Part 2.

Notice of Appointment of Counsel

for an indigent indian PARENT/CUSTODIAN

Notice is hereby given pursuant to Section 1912(b) of the Indian Child Welfare Act (“ICWA”), that counsel has been appointed for an indigent Indian parent/custodian in an involuntary Indian child custody proceeding for which the appointment of counsel is not authorized under state law.

1. Information on the Indian parent/custodian (client) is as follows:

   1. Name of Indian parent/custodian: ______________________________________

   2. Address of Indian parent/custodian: ____________________________________

   3. Relationship of client to Indian child: ___________________________________

   4. Name of Indian child’s tribe: __________________________________________

2. Information on the appointed counsel is as follows:

   1. Name of appointed counsel: ___________________________________________

   2. Address of appointed counsel: _________________________________________

   3. Telephone of appointed counsel: _______________________________________

CERTIFICATION

Pursuant to 25 C.F.R. § 23.13(a), I, the Honorable ______________________________, Judge of the ____________________________ County, State of _________________________, do certify that state law does not provide for the appointment of counsel in involuntary Indian child custody proceedings and that the above-listed parent/Indian custodian is an indigent client.

Certified this __________ day of __________________. 20_____.

____________________________________

Judge

Purpose: A State court must supply specific information to the Bureau of Indian Affairs (BIA) when it appoints counsel for an indigent Indian party in an involuntary Indian child custody proceeding when the appointment of counsel is not authorized under State law, 25 CFR 23.13(a). This information is necessary for the BIA to decide whether to certify that the client in the notice is eligible to have his counsel compensated by the BIA in accordance with the Indian Child Welfare Act, Public Law 95-608, 92 Stat. 3069, 25 U.S.C. § 1912(b), and 25 CFR § 23.13.

Paperwork Reduction Act Statement: We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) for the Request for Payment for Appointed Counsel in Involuntary Indian Child Custody Proceedings in State Courts. Your response is voluntary and we will not share the results publicly. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB Control Number. OMB has reviewed and approved this survey and assigned OMB Control Number 1076- 0111, which expires XX/XX/XXXXX.

Estimated Burden Statement: We estimate the Request for Payment will take you 6 hours to complete, including time to read instructions, gather information, and complete and submit the Request for Payment. You may submit comments on any aspect of this information collection to the Information Collection Clearance Officer, Office of Regulatory Affairs & Collaborative Action, Indian Affairs, U.S. Department of the Interior, 1001 Indian School Road NW, Suite 229, Albuquerque, New Mexico 87104.

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