Information Collection

2 - Respond to State regarding Tribal membership

IC 215209 under ICR 202508-1076-004 · OMB 1076-0186.

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Information Collection (IC) Details

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IC Title:	2 - Respond to State regarding Tribal membership	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 23.108 25 CFR 23.109

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Litigation and Judicial Activities

Subfunction: Judicial Hearing

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 567	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	13,041	0	13,041
Annual IC Time Burden (Hours)	13,041	0	13,041
Annual IC Cost Burden (Dollars)	38,080	21,648	16,432

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