Application for Admission to Haskell Indian Nations University and to Southwestern Indian Polytechnic Institute

Forms and Documents

Document Name	Status
Application for admission to SIPI Form	Modified
Application for Admission to Haskell Indian Nations University Form	Modified
30-Day Haskell 1076-0114.pdf Supplementary Document	2021-03-26
2021 Supporting Statement 1076-0114 (App for Haskell and SIPI) - FINAL.docx Supporting Statement A	2021-03-16
2020-Haskell and SIPI 60 day notice.pdf Supplementary Document	2021-03-15
BIA-22 Privacy Act System of Record - Indian Student Records.pdf Supplementary Document	2012-03-12
Public Law 99_228.pdf Supplementary Document	2008-12-03
25 USCS 13.pdf Supplementary Document	2008-10-22
Public Law 95_561.pdf Supplementary Document	2008-10-21

IC Document Collections

IC ID	Document Title	Status
187215	Application for admission to SIPI Form	Modified
11490	Application for Admission to Haskell Indian Nations University Form	Modified

ICR Details

OMB Control No: 1076-0114	ICR Reference No: 202103-1076-004
Status: Received in OIRA	Previous ICR Reference No: 201711-1076-001
Agency/Subagency: DOI/BIA	Agency Tracking No:
Title: Application for Admission to Haskell Indian Nations University and to Southwestern Indian Polytechnic Institute
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/26/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2021
Responses	2,100	4,000
Time Burden (Hours)	800	1,750
Cost Burden (Dollars)	11,155	10,000

---

Abstract: These forms are used to collect information to determine eligibility of respondent for admission to post secondary education administered by the Bureau of Indian Education.

---

Authorizing Statute(s): Statute at Large: 48 Stat. 180 Name of Statute: Indian Appropriations of the 48th Congress
   PL: Pub.L. 95 - 561 1102 Name of Law: Education Amendments of 1978
   Statute at Large: 25 Stat. 13 Name of Statute: the Snyder Act
   Statute at Large: 99 Stat. 1747 Name of Statute: Blood Quantum Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 76100	11/27/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 16235	03/26/2021
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Application for Admission to Haskell Indian Nations University	N/A	Application for Admission to Haskell Indian Nations University
Application for admission to SIPI	n/a	Application for Admission Southwestern Indian Polytechnic Institute (SIPI)

---

ICR Summary 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	2,100	4,000	0	0	-1,900	0
Annual Time Burden (Hours)	800	1,750	0	0	-950	0
Annual Cost Burden (Dollars)	11,155	10,000	0	0	1,155	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:

---

Annual Cost to Federal Government: $88,142

Does this IC contain surveys, censuses, or employ statistical methods? No

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.     Yes

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.     Yes

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

---

Common Form ICR:  No

---

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: 03/26/2021

---