Information Collection

MICS 543.23(d)

IC 204504 under ICR 202511-3141-003 · OMB 3141-0009.

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Information Collection (IC) Details

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IC Title:	MICS 543.23(d)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 25 CFR 543.23(d)

Information Collection Instruments:

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

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 204	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	418	-4	2	420
Annual IC Time Burden (Hours)	84	0	-906	990
Annual IC Cost Burden (Dollars)	3,855,600	0	568,800	3,286,800

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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