Information Collection

Leasehold Mortgage Lender Checklist

IC 239945 under ICR 202212-1076-002 · OMB 1076-0195.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0195 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Leasehold Mortgage Lender Checklist	Form and Instruction
Leasehold Mortgage Lender Checklist Leasehold Mortgage Lender Checklist (3).docx www.bia.gov/policy-forms/online-forms	Form and Instruction

IC Title:

Leasehold Mortgage Lender Checklist

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 25 CFR 152.34

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	Leasehold Mortgage Lender Checklist	Leasehold Mortgage Lender Checklist (3).docx	https://www.bia.gov/policy-forms/online-forms	Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records

Title: BIA-12: Indian Trust Land Mortgages

FR Citation: 48 FR 41105

Number of Respondents: 31

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	61	61
Annual IC Time Burden (Hours)	2,440	2,440
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.