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Federal forms, ICRs, and supporting documents

OMB control number

Electrical Power Service Application, 25 CFR 175

OMB 1076-0021 ยท DOI/BIA.

OMB 1076-0021

The BIA owns, operates, and maintains three electric power utilities that provide a service to the end user, pursuant to 25 CFR 175 (Indian Electric Power Utilities). The BIA must collect customer information to identify the individual responsible for repaying the government its costs for delivering the service and bill for those costs. The BIA must also collect information to identify the location of the service delivery (i.e., electrical hook-up). In addition, the Debt Collection Improvement Act of 1996 (DCIA), 31 U.S.C. 3701-3733 requires that certain information be collected from individuals and businesses doing business with the government. This information includes the taxpayer identification number for possible future use to recover delinquent debt.

The latest form for Electrical Power Service Application, 25 CFR 175 expires 2026-08-31 and is listed under ICR 202208-1076-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Electric Service ApplicationForm and Instruction
91 FR 13318.pdfSupplementary Document
90 FR 44212.pdfSupplementary Document
IAFR001571__Supporting Statement A (1076-0021).docxSupporting Statement A
86 FR 50156.pdfSupplementary Document
79 FR 24002.pdfSupplementary Document
25 CFR 175.pdfSupplementary Document
Debt Collection Improvement Act.pdfSupplementary Document
Electrical Power Service Application, 25 CFR 175 Form and Instruction
Electrical Power Service Application, 25 CFR 175 Form and Instruction
Letter from medical services provider, 25 CFR 175 Information collection

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202508-1076-003 Extension without change of a currently approved collection 2026-03-19
202208-1076-002 Revision of a currently approved collection 2022-09-26 Approved without change
201906-1076-007 Revision of a currently approved collection 2019-06-26 Approved without change
201603-1076-003 Extension without change of a currently approved collection 2016-03-31 Approved without change
201210-1076-001 Extension without change of a currently approved collection 2012-12-28 Approved without change
200904-1076-004 Extension without change of a currently approved collection 2009-08-31 Approved without change
200607-1076-002 Reinstatement with change of a previously approved collection 2006-07-11 Approved without change
200302-1076-001 Extension without change of a currently approved collection 2003-02-11 Approved without change
199909-1076-002 Extension without change of a currently approved collection 1999-09-30 Approved without change
199606-1076-002 Reinstatement with change of a previously approved collection 1996-06-03 Approved without change
199102-1076-002 Reinstatement with change of a previously approved collection 1991-02-28 Approved without change
198806-1076-001 Reinstatement with change of a previously approved collection 1988-06-30 Approved without change
198506-1076-001 Reinstatement with change of a previously approved collection 1985-06-13 Approved without change
198201-1076-006 New collection (Request for a new OMB Control Number) 1982-01-06 Approved without change

OMB Details

Electrical Power Service Application, 25 CFR 175

Federal Enterprise Architecture: Energy - Energy Supply

Information collection instruments
FormNameElectronic accessType
Form N/AElectric Service Applicationwww.bia.gov/policy-forms/online-formsForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.