IACB App. Source Directory Business Listing Application

OMB #: 1085-0001

Expires: XX/XX/2024

Indian Arts and Crafts Board

Source Directory Business Listing Application

Please check the appropriate box:

New Listing Renewal/Changes

Individual Group

Return To: U.S. Department of the Interior

Indian Arts and Crafts Board

1849 C Street, NW, MS 2528-MIB

Washington, DC 20240

Email: [email protected]

Fax: 1-202-208-5196

Please print or type your business information (see samples included):

Please print or type

Business name: ____________________________________________________________________________________________

Manager name: ____________________________________________

Owner name: ______________________________________________ Tribe: ___________________________________

CERTIFICATION: I certify that I am the owner of this enterprise and that I am an enrolled member of a federally recognized American Indian tribe or Alaska Native group. (A willfully false certification is a criminal offense [18 U.S.C. 1001] ):

Signature: ________________________________________________ Date: ____________________________________

Notice: By filling out this form you are consenting to make this information available to the public through the Source Directory. Please only include information that you wish to make available to the public.

Paperwork Reduction Act Statement: This information is collected to identify and revise listings for the Source Directory of American Indian and Alaska Native owned and operated arts and crafts businesses. The information is supplied by the respondent to obtain or retain a benefit, that is, inclusion in the Source Directory. It is estimated that responding to the request will take an average of 15 minutes to complete. This includes the amount of time it takes to gather the information and fill out the form. If you wish to make comments on the form, please send them to the Director, Indian Arts and Crafts Board, 1849 C Street N.W., MS 2528-MIB, Washington, D.C. 20240. Note: Comments, names and addresses of commentators are available for public review during regular business hours. If you wish us to withhold this information, you must state this prominently at the beginning of your comment. We will honor your request to the extent allowable by law. In compliance with the Paperwork Reduction Act of 1995, as amended, the collection has been reviewed by the Office of Management and Budget and assigned a control number and expiration date. The number and expiration date are at the top right corner of the form. Please note that an agency may not conduct or sponsor, and person is not required to respond to, a collection of information unless there is currently a valid OMB control number.

Notice: Penalty for Misrepresentation

It is unlawful to offer or display for sale or sell any good, with or without a Government trademark, in a manner that falsely suggests it is Indian produced, an Indian product, or the product of a particular Indian or Indian tribe or Indian arts and crafts organization, resident within the United States. Any person that knowingly violates this law shall be subject to a fine and/or imprisonment.

[18 U.S.C. 1159]

For purposes of this law, the term “Indian” means any individual who is a member of an Indian tribe, or for the purposes of this section is certified as an Indian artisan by an Indian tribe. The term “Indian tribe” has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b) and includes, for purposes of this section only, an Indian group that has been formally recognized as an Indian tribe by a State legislature; a State commission; or another similar organization vested with State legislative tribal recognition authority.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Hill, Michele K
File Modified	0000-00-00
File Created	2024-07-26