Indian Affairs Public Health Needs Assessment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Indian Affairs Public Health Needs Assessment Survey	Form and Instruction	Unchanged	Available
Indian Affairs Public Health Needs Assessment Survey	Form and Instruction	Unchanged	Available
90 FR 45405.pdf	Supplementary Document	Uploaded 2025-09-23	Available
90 FR 24288.pdf	Supplementary Document	Uploaded 2025-08-26	Available
IAFR001470__SSB_Public Health Needs Assessment.docx	Supporting Statement B	Uploaded 2025-08-26	Available
IAFR001470__SSA_Public Health Needs Assessment.docx	Supporting Statement A	Uploaded 2025-08-26	Available
Occupational Safety and Health Act of 1970 (PL).pdf	Supplementary Document	Uploaded 2022-10-07	Available
Occupational Safety and Health Act of 1970 (USC).pdf	Supplementary Document	Uploaded 2022-10-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
256326	Survey (Individuals)	Form and Instruction	Unchanged	Indian Affairs Public Health Needs Assessment Survey
256325	Survey (State, Local, Tribal Governments)	Form and Instruction	Unchanged	Indian Affairs Public Health Needs Assessment Survey

ICR Details

OMB Control No: 1076-0200	ICR Reference No: 202505-1076-001
Status: Received in OIRA	Previous ICR Reference No: 202210-1076-002
Agency/Subagency: DOI/BIA	Agency Tracking No: IAFR001470, IAFR001484
Title: Indian Affairs Public Health Needs Assessment
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/23/2025

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	1,000	1,000
Time Burden (Hours)	167	167
Cost Burden (Dollars)	0	0

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Abstract: Enhancing the public health and safety capacity throughout Indian Affairs is a force multiplier in achieving the goals of our agency and in meeting the Occupational Safety and Health Act of 1970, Section 5 directive to create a place of employment free from recognized hazards. The purpose of this survey is to identify and prioritize public health issues and needs and enhance the public health and safety capacity throughout Indian country. The Office of Facilities, Property and Safety Management (OFPSM) Public Health and Safety (PHS) Team will use survey results to develop and coordinate action plans.

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Authorizing Statute(s): PL: Pub.L. 91 - 596 5 Name of Law: Occupational Safety and Health Act of 1970
   US Code: 29 USC 654 Name of Law: Occupational Safety and Health Act of 1970
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 24288	06/09/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 45405	09/22/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Survey (Individuals)	N/A	Indian Affairs Public Health Needs Assessment Survey
Survey (State, Local, Tribal Governments)	N/A	Indian Affairs Public Health Needs Assessment Survey

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,000	1,000	0	0	0	0
Annual Time Burden (Hours)	167	167	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $16,505

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/23/2025

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