Information Collection

Subpart P: Annual self-governance report

IC 190042 under ICR 202405-1076-004 · OMB 1076-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0143 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Subpart P: Annual self-governance report	Form
1076-0143 Form 1076-0143 Form.docx www.bia.gov/policy-forms/online-forms/paperwork-reduction-act	Form
1076-0143 Form 1076-0143 Form.docx www.bia.gov/policy-forms/online-forms/paperwork-reduction-act	Form

IC Title:

Subpart P: Annual self-governance report

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 1000.2025 25 CFR 1000.2030 25 CFR 1000.1020

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	N/A	1076-0143 Form	1076-0143 Form.docx	https://www.bia.gov/policy-forms/online-forms/paperwork-reduction-act	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 33

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	33	33
Annual IC Time Burden (Hours)	2,112	2,112
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.