Online Forms

Title	Description
Accounts Payable (AP) Return of Funds Form	[Note: This form is for IA Internal Use Only] Please use this form for Return of Funds originating from an Accounts Payable or ASAP Payment Transactions
Application for Restoration of Annual Leave	[Note: This form is for IA Internal Use Only] Request to restore annual leave
Approved Deviation from the Buy Indian Act	[Note: This form is for IA Internal Use Only] Memorandum/form
BIA 2501 - Safety Management Quarterly and Cumulative Report	[Note: This form is for IA Internal Use Only] This is an Excel form used by the Division of Safety & Risk Management (see 25 IAM 3) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
BIA 2502 - Tort Claim Payments and Third Party Recoveries	[Note: This form is for IA Internal Use Only] This is an Excel form used by the Division of Safety & Risk Management (see 25 IAM 5) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
BIA 2503 - Property Damage from Accidental Causes	[Note: This form is for IA Internal Use Only] This is an Excel form used by the Division of Safety & Risk Management (see 25 IAM 3) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
BIA 2504 - Occupational Injuries and Illnesses	[Note: This form is for IA Internal Use Only] This is an Excel form used by the Division of Safety & Risk Management (see 25 IAM 6) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
BIA 2505 - Fire Damage	[Note: This form is for IA Internal Use Only] This is an Excel form used by the Division of Safety & Risk Management (see 25 IAM 3) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
BIA 2506 - Safety Training	[Note: This form is for IA Internal Use Only] This is an Excel form used by the Division of Safety & Risk Management (see 25 IAM 3) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
BIA 4287 - Request for Relief of Collection Officer	Used for requesting relief on behalf of a Collection Officer when a loss has been incurred. Instructions are also included.
BIA 4311 - Receiving Report	[Note: This form is for IA Internal Use Only]
BIA 4314 - Requisition	[Note: This form is for IA Internal Use Only] This form is for purchases up to the micropurchase threshold; all other purchases should use the "BIA/BIE Electronic Purchase Request (EPR) Form".
BIA 4335 - Donation of Personal Property to Indian Tribes or Tribal Organizations	[Note: This form is for IA Internal Use Only] This form is used by the Division of Property Management.
BIA 4432 - Verification of Indian Preference for Employment	*See the IA Paperwork Reduction Act (PRA) tab for this form*
BIA/BIE Electronic Purchase Request (EPR) Form	[Note: This form is for IA Internal Use Only] If the FBMS approval will not be completed by the direct program supervisor, this form must be completed by the requesting program or school and signed by the cost center supervisor (at a minimum). See 22 IAM 3 for additional details.
BIA/BIE eQIP Request Form	[Note: This form is for IA Internal Use Only] Form created by the Office of Human Capital Management
BIE Section 504 Checklist	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Consent for Initial Evaluation Form	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Consent to Review Evaluative Information	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Eligibility Determination Form	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Identification Determination Summary	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Individualized Accommodation Plan (IAP)	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Invitation to 504 Meeting	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Manifestation Determination Form	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Parent Input Form	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Rights and Procedural Safeguards Form	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
BIE Section 504 Teacher Input Form	BIE uses these forms to implement NPM-EDUC-33: Section 504 of the Rehabilitation Act of 1973.
Buy Indian Act Compliance Review Checklist	[Note: This form is for IA Internal Use Only] Checklist
Capitalized ABZON Request Form	[Note: This form is for IA Internal Use Only]
Carryover Appeal Request Form	[Note: This form is for IA Internal Use Only] This form is used to submit a carryover funding request to the DAS-M
Categorical Exclusion Exception Review (CEER) Checklist	[Note: This form is for IA Internal Use Only] Checklist that can be used to facilitate compliance with the National Environmental Policy Act (NEPA); also used as part of the Housing Improvement Program (HIP)
CDIB Form	*See the IA Paperwork Reduction Act (PRA) tab for this form*
Certification of Final Inspection	Form used as part of the Housing Improvement Program (HIP)
Certification of Permanently Corrected Deficiencies	[Note: This form is for IA Internal Use Only] This is a Word form used by the Division of Safety and Risk Management *(please open using Chrome due to issues with IE and Excel/Word docs.)*
Certification of Preliminary Site Evaluation	Form used as part of the Housing Improvement Program (HIP)
Checklist for HIP Applications	Form used as part of the Housing Improvement Program (HIP)
Deed Form - AIPRA	Form used by the Pacific Region
Deed Form - Special
Deed Form - Standard	Form used by the Pacific Region
Environmental and Disposal Liability Location of Concern (LOC) Notification Form
Equipment Operation Data Form	(Formerly DI-120) Division of Property Excel form used by programs to document monthly fleet utilization *(note:* *please open using Chrome due to issues with IE and Excel/Word docs.)*
Equipment Operation Data Form	[Note: This form is for IA Internal Use Only] This form is used by the Division of Property Management (Excel) (note: please open using Chrome due to issues with IE and Excel/Word docs.)
Exit Clearance Form	[Note: This form is for IA Internal Use Only] This (Word) form applies to ASIA, BIA, and BIE (note: please open using Chrome due to issues with IE and Excel/Word docs.)
FBMS FED Excel Form Instructions	Instructions for the Excel upload
FBMS FED Form - Excel Form	Excel upload file (note: please open using Chrome due to issues with IE and Excel/Word docs.)
FBMS FED Form and Instructions	Data entry form and instructions
FBMS Paper Purchase Request Form	This form is no longer in use; see the "BIA 4314 - Requisition" form or the "BIA/BIE Electronic Purchase Request (EPR) Form".
Federal Register documents: DOI Briefing Paper Template	[Note: This form is for IA Internal Use Only] Template (Word) used to obtain Departmental clearance for Federal Register documents (*please open using Chrome due to issues with IE and Excel/Word docs.)*
Federal Register documents: Formatting Checklist	[Note: This form is for IA Internal Use Only] Checklist
Financial Assistance and Social Services Report (FASSR)	Welfare Assistance program form (Excel) (note: please open using Chrome due to issues with IE and Excel/Word docs.)
General Purpose Receipt (BIA 5-777)	IA Accounting Operations form
HIP - Authorization to Release Information	Form used as part of the Housing Improvement Program (HIP)
HIP - Grant Agreement (Sample)	Form used as part of the Housing Improvement Program (HIP)
Hiring Controls form - ASIA/BIE	[Note: This form is for IA Internal Use Only] This is a Word form that serves as an exemption request for hiring controls for use by ASIA and BIE (*please open using Chrome due to issues with IE and Excel/Word docs.)*
Hiring Controls form - BIA	[Note: This form is for IA Internal Use Only] This form serves as an exemption request for hiring controls for use by BIA.
IA Annual Incidental Motor Vehicle Operator's Certification	[Note: This document is for IA Internal Use Only] This certification statement is completed annually by incidental motor vehicle operators (see 25 IAM 4 for more details).
IA Compressed Work Schedule Agreement	[Note: This form is for IA Internal Use Only] Request for Compressed work schedule
IA Flexitime (Gliding Schedule) Work Schedule Agreement	[Note: This form is for IA Internal Use Only] Request for Flexitime work schedule
IA Maxiflex Work Schedule Agreement	[Note: This form is for IA Internal Use Only] Request for Maxiflex work schedule
IA Motor Vehicle Operator Authorization Card	[Note: This document is for IA Internal Use Only] This is the template used by the Division of Safety and Risk Management to issue Motor Vehicle Operator Authorization cards
IA Waiver Request Form	IT acquisition related
IIM Accounts: Assessment and Evaluation Form	This form is used as part of the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.
IIM Accounts: Assessment Request - Outside of Service Area Procedures	This guidance is related to the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.
IIM Accounts: Distribution Plan Form	This form is used as part of the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.
IIM Accounts: Major Purchase Request Worksheet	This form is used as part of the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.
IIM Accounts: Six Month Case File Review Form	This form is used as part of the BIA's Office of Indian Services Division of Human Services' supervised Individual Indian Money (IIM) program.
Impaired Fire Protection Systems Quarterly Report	[Note: This form is for IA Internal Use Only] This is an Excel form used by the Division of Safety & Risk Management (see 25 IAM 3) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
Indian Affairs Harassing Conduct Allegation Intake Form	[Note: This form is for IA Internal Use Only] This form should be used by all IA officials to record a report of harassing conduct.
Justification for Space	[Note: This form is for IA Internal Use Only] Space Management
Land Description Review Worksheet
Logistics Service/Transfer of Equipment Request	This is a combined form that should be used when requesting any services from the Indian Affairs Logistics Office or when requesting any piece of equipment or sensitive minor item with an Indian Affairs/DOI Inventory Tag be moved from one location to another.
Mortgage HB Attachment 2: Leasehold Mortgage Lender Checklist	*See the IA Paperwork Reduction Act (PRA) tab for this form.* This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 3: Leasehold Mortgage Loan Checklist	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 4: Leasehold Acknowledgement Incomplete Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 5: Leasehold Acknowledgement Complete Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 6: Leasehold ROW Acknowledgement Complete Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 7: NEPA Cat Ex Checklist	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 8: Superintendent Recommendation Memorandum	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 9: Leasehold Approved Decision Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 10: Leasehold Certificate of Approval	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 11: Leasehold Disapproval Decision Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 12: Leasehold Lender Transmittal Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 13: Trust Land Mortgage Loan Checklist	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 14: Land Mortgage Acknowledgement Incomplete Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 15: Land Mortgage Agency Transmittal Memorandum	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 16: Trust Land Mortgage Commitment to Approve Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 17: BIA Disclosure Statement	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 18: Land Mortgage Certificate of Approval	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 19: Land Mortgage Disapproval Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 20: Land Mortgage Lender Transmittal Letter	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 21: RD Recommendation Memorandum	This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Mortgage HB Attachment 22: Land Mortgage Lender Loan Checklist	*See the IA Paperwork Reduction Act (PRA) tab for this form.* This form is used as part of the mortgage process, as described in 52 IAM 4-H. (Word version only)
Motor Vehicle Operator Report	[Note: This document is for IA Internal Use Only] This is the report template (Excel) to be used by Safety Managers as detailed in 25 IAM 4. (note: please open using Chrome due to issues with IE and Excel/Word docs.)
Notice of Designation (BIA 4285)	IA Accounting Operations form
Notice of Hazard Identification Quarterly Report	[Note: This form is for IA Internal Use Only] This is an Excel form used by the Division of Safety & Risk Management (see 25 IAM 3) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
Notice of Project Completion	Form used as part of the Housing Improvement Program (HIP)
Obligation in Expired Fund Request Form	This form is intended for use when requesting an FBMS override to record an obligation in an expired fund
Occupational Safety and Health Program Evaluation Corrective Action Plan	[Note: This form is for IA Internal Use Only] This is a Word form used by the Division of Safety & Risk Management (see 25 IAM 3) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
OSHA Notice and/or Site Visit Quarterly Report	[Note: This form is for IA Internal Use Only] This is an Excel form used by the Division of Safety & Risk Management (see 25 IAM 3) (*please open using Chrome due to issues with IE and Excel/Word docs.)*
Petition for Partition	Form used by the Pacific Region

Pages

OMB Number	Title	Description
1076-0017	Application for Financial Assistance and Social Services	Any individual or family may apply for BIA Financial Assistance and Social Services by completing the application process with the assistance of the Social Worker. A Word version of the Application for Financial Assistance and Social Services (FASS) and Individual Self-Sufficiency (ISP)/Case Plan is available on the Division of Human Services website: https://www.bia.gov/bia/ois/dhs/financial-assistance.
1076-0017	1076-0017		Individual Self-Sufficiency Plan (ISP)/Case Plan	Any individual or family may apply for BIA Financial Assistance and Social Services by completing the application process with the assistance of the Social Worker. A Word version of the Application for Financial Assistance and Social Services (FASS) and Individual Self-Sufficiency (ISP)/Case Plan is available on the Division of Human Services website: https://www.bia.gov/bia/ois/dhs/financial-assistance.
1076-0018	Tribal Colleges and Universities Grant Application	The Tribally Controlled Community College Assistance Act of 1978 (25 U.S.C. 1802-1815) allows for tribally controlled community colleges to apply for grants for the purpose of ensuring continued and expanded education opportunities for American Indian and Alaska Native students. The implementing regulations at 25 CFR 41 establishes the process for tribally controlled colleges to apply for the grants. For more information, please visit bie.edu.
1076-0020	Assignment of Loan Documents and Related Rights	The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk. The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements. The forms are available on the Division of Capital Investment website (located at the bottom of the page): https://www.bia.gov/as-ia/ieed/division-capital-investment.
	1076-0020		Claim for Loss	The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk. The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements. The forms are available on the Division of Capital Investment website (located at the bottom of the page): https://www.bia.gov/as-ia/ieed/division-capital-investment.
	1076-0020		Interest Subsidy Report	The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk. The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements. The forms are available on the Division of Capital Investment website (located at the bottom of the page): https://www.bia.gov/as-ia/ieed/division-capital-investment.
	1076-0020		Loan Guarantee Agreement	The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk. The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements. The forms are available on the Division of Capital Investment website (located at the bottom of the page): https://www.bia.gov/as-ia/ieed/division-capital-investment.
	1076-0020		Loan Insurance Agreement	The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk. The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements. The forms are available on the Division of Capital Investment website (located at the bottom of the page): https://www.bia.gov/as-ia/ieed/division-capital-investment.
	1076-0020		Notice of Default	The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk. The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements. The forms are available on the Division of Capital Investment website (located at the bottom of the page): https://www.bia.gov/as-ia/ieed/division-capital-investment.
	1076-0020		Notice of Insured Loan	The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk. The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements. The forms are available on the Division of Capital Investment website (located at the bottom of the page): https://www.bia.gov/as-ia/ieed/division-capital-investment.
	1076-0020		Request for Loan Guarantee, Loan Insurance, and/or Interest Subsidy	The Office of Indian Energy and Economic Development (IEED) implements the Loan Guarantee, Insurance, and Interest Subsidy Program, 25 U.S.C. 1451, et seq., the purpose of which is to encourage private lending to individual Indians and Indian organizations by providing lenders with loan guarantees or loan insurance to reduce their potential risk. The forms associated with this collection allows IEED to determine the eligibility and credit-worthiness of respondents and loans and otherwise ensure compliance with program requirements. The forms are available on the Division of Capital Investment website (located at the bottom of the page): https://www.bia.gov/as-ia/ieed/division-capital-investment.
1076-0021	Electrical Service Application	BIA collects information to operate and maintain it's electric power utilities to serve electric power consumers and to fulfill reporting requirements.
1076-0047	Reindeer Sale Permit and Report Form	These forms are collected to monitor and regulation the possession and use of Alaskan reindeer by non-Natives in Alaska. An applicant must fill out an application for a permit to get a reindeer for any purpose, and is required to report on the status of reindeer annually or when change occurs, including changing prior to the date of the annual report.
	1076-0047		Special Use Permit for Public Display of Alaska Reindeer	These forms are collected to monitor and regulation the possession and use of Alaskan reindeer by non-Natives in Alaska. An applicant must fill out an application for a permit to get a reindeer for any purpose, and is required to report on the status of reindeer annually or when change occurs, including changing prior to the date of the annual report.
	1076-0047		Special Use Reindeer Report	These forms are collected to monitor and regulation the possession and use of Alaskan reindeer by non-Natives in Alaska. An applicant must fill out an application for a permit to get a reindeer for any purpose, and is required to report on the status of reindeer annually or when change occurs, including changing prior to the date of the annual report.
1076-0094	Dissolution of Marriage Application	Marriage License Application and Dissolution of Marriage Application
1076-0094	1076-0094		Marriage License Application	Marriage License Application and Dissolution of Marriage Application
1076-0104	Ancestry Chart (BIA-8305) (MS-Word)	Groups seeking Federal acknowledgment under 25 CFR 83 may use the following forms under OMB# 1076-0104 (which includes BIA forms 8304 (Individual History Chart), 8305 (Ancestry Chart) and 8306 (Membership Roll)) to provide a complete list of members of the group seeking recognition. Groups may submit the information on their own forms.
	1076-0104		Ancestry Chart (BIA-8305) (PDF)	Groups seeking Federal acknowledgment under 25 CFR 83 may use the following forms under OMB# 1076-0104 (which includes BIA forms 8304 (Individual History Chart), 8305 (Ancestry Chart) and 8306 (Membership Roll)) to provide a complete list of members of the group seeking recognition. Groups may submit the information on their own forms.
	1076-0104		Individual History Chart (BIA-8304) (MS-Word)	Groups seeking Federal acknowledgment under 25 CFR 83 may use the following forms under OMB# 1076-0104 (which includes BIA forms 8304 (Individual History Chart), 8305 (Ancestry Chart) and 8306 (Membership Roll)) to provide a complete list of members of the group seeking recognition. Groups may submit the information on their own forms.
	1076-0104		Individual History Chart (BIA-8304) (PDF)	Groups seeking Federal acknowledgment under 25 CFR 83 may use the following forms under OMB# 1076-0104 (which includes BIA forms 8304 (Individual History Chart), 8305 (Ancestry Chart) and 8306 (Membership Roll)) to provide a complete list of members of the group seeking recognition. Groups may submit the information on their own forms.
	1076-0104		Membership Roll (BIA-8306) (MS-Word)	Groups seeking Federal acknowledgment under 25 CFR 83 may use the following forms under OMB# 1076-0104 (which includes BIA forms 8304 (Individual History Chart), 8305 (Ancestry Chart) and 8306 (Membership Roll)) to provide a complete list of members of the group seeking recognition. Groups may submit the information on their own forms.
	1076-0104		Membership Roll (BIA-8306) (PDF)	Groups seeking Federal acknowledgment under 25 CFR 83 may use the following forms under OMB# 1076-0104 (which includes BIA forms 8304 (Individual History Chart), 8305 (Ancestry Chart) and 8306 (Membership Roll)) to provide a complete list of members of the group seeking recognition. Groups may submit the information on their own forms.
1076-0114	Haskell Indian Nations University Admission Application	For more information regarding admission to Haskell Indian Nations University, please visit Haskell's website: https://www.haskell.edu/. For more information regarding admission to Southwestern Indian Polytechnic Institute (SIPI), please visit SIPI's website: https://www.sipi.edu/.
1076-0114	1076-0114		Southwestern Indian Polytechnic Institute (SIPI) Admission Application	For more information regarding admission to Haskell Indian Nations University, please visit Haskell's website: https://www.haskell.edu/. For more information regarding admission to Southwestern Indian Polytechnic Institute (SIPI), please visit SIPI's website: https://www.sipi.edu/.
1076-0120	Adult Education Annual Report Form	The Bureau of Indian Education (BIE) annually collects information to prioritize programs and measure the success of programs. This annual report helps manage the resources available to provide education opportunities for adult Indians and Alaska Natives to complete high school graduation requirements and gain new skills and knowledge for their self-enhancement. For more information on the Adult Education program, please visit www.bie.edu.
1076-0122	Data Elements for Student Enrollment in Bureau-funded Schools	This form is used for by Bureau-funded school registrars to collect information to determine student's eligibility for enrollment in a Bureau-funded school. If eligible, the information is shared with appropriate schools officials to identify the student's base and supplemental educational and/or residential program needs.
1076-0131	Indian Child Welfare Quarterly and Annual Report	The BIA collects information using the consolidated caseload form, which tribal ICWA program directors complete. BIA uses the information to determine the extent of service needs in local Indian communities, assess ICWA program effectiveness, and provide data for the annual program budget justification.
1076-0134	BIE Indian School Equalization Program (ISEP) Student Transportation Form	This form is used by Bureau-funded Schools to determine the rate per mile and allocation of transportation funds. The Student Transportation regulations in 25 CFR part 39, subpart G, contain the program eligibility and criteria that govern the allocation of transportation funds. This information is also collected using a web-based system, Web Education Transportation (Web ET).
1076-0135	477 Financial Report Form and Instructions (Excel)	Reporting System for P.L. 102-477 Demonstration Project
	1076-0135		477 Narrative Report	Reporting System for P.L. 102-477 Demonstration Project
	1076-0135		477 Statistical Report and Instructions	Reporting System for P.L. 102-477 Demonstration Project
	1076-0135		Application for Job Placement and/or Training Assistance	Reporting System for P.L. 102-477 Demonstration Project
1076-0141	Annual Assessment Waiver Application	In order for irrigators to receive water deliveries, information is needed by the BIA to operate and maintain its irrigation projects and fulfill reporting requirements. Water users must apply for water delivery and for a number of other associated services, such as, subsidizing a farm unit, requesting leaching service, requesting water for domestic or stock purposes, building structures or fences in BIA rights-of-way, requesting payment plans on bills, establishing a carriage agreement with a third-party, negotiating irrigation incentives leases, and requesting an assessment waiver.
	1076-0141		Incentive Agreement	In order for irrigators to receive water deliveries, information is needed by the BIA to operate and maintain its irrigation projects and fulfill reporting requirements. Water users must apply for water delivery and for a number of other associated services, such as, subsidizing a farm unit, requesting leaching service, requesting water for domestic or stock purposes, building structures or fences in BIA rights-of-way, requesting payment plans on bills, establishing a carriage agreement with a third-party, negotiating irrigation incentives leases, and requesting an assessment waiver.
	1076-0141		Land Classification/Designation Application	In order for irrigators to receive water deliveries, information is needed by the BIA to operate and maintain its irrigation projects and fulfill reporting requirements. Water users must apply for water delivery and for a number of other associated services, such as, subsidizing a farm unit, requesting leaching service, requesting water for domestic or stock purposes, building structures or fences in BIA rights-of-way, requesting payment plans on bills, establishing a carriage agreement with a third-party, negotiating irrigation incentives leases, and requesting an assessment waiver.
	1076-0141		Request for Customer Information	In order for irrigators to receive water deliveries, information is needed by the BIA to operate and maintain its irrigation projects and fulfill reporting requirements. Water users must apply for water delivery and for a number of other associated services, such as, subsidizing a farm unit, requesting leaching service, requesting water for domestic or stock purposes, building structures or fences in BIA rights-of-way, requesting payment plans on bills, establishing a carriage agreement with a third-party, negotiating irrigation incentives leases, and requesting an assessment waiver.
	1076-0141		Request for Irrigation Services	In order for irrigators to receive water deliveries, information is needed by the BIA to operate and maintain its irrigation projects and fulfill reporting requirements. Water users must apply for water delivery and for a number of other associated services, such as, subsidizing a farm unit, requesting leaching service, requesting water for domestic or stock purposes, building structures or fences in BIA rights-of-way, requesting payment plans on bills, establishing a carriage agreement with a third-party, negotiating irrigation incentives leases, and requesting an assessment waiver.
1076-0143	Self-Governance Minimum Data Collection	Tribes and Tribal consortia that have entered into Self-Governance funding agreements are requested to submit certain information as described in 25 CFR part 1000.
1076-0153	CDIB (PDF)	This is the Certificate of Degree of Indian or Alaska Native Blood (CDIB) form. Instructions are included with the form.
1076-0157	Form 5-5243 - Performance Bond	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5514 - Bid for Grazing Privileges	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5515 - Grazing Permit	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5516 - Grazing Permit for Organized Tribes	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5517 - Free Grazing Permit	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5519 - Cash Penal Bond for Grazing Permits	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5520 - Power of Attorney	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5521 - Certificate and Application for On-and-Off Grazing Permit	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5522 - Modification of Grazing Permit (Form 5-5515)	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5523 - Assignment of Grazing Permit	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5524 - Application for Allocation of Grazing Privileges	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5525 - Authority to Grant Grazing Privileges on Allotted Lands	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5528 - Livestock Crossing Permit	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
	1076-0157		Form 5-5529 - Removable Range Improvement Records	Grazing Permits The parties submitting information are Tribes, Tribal organizations authorized by Indian Tribal governments, individual Indians, and non-Indians seeking grazing permits on land held by the U.S. Government in trust for Tribes and individual indians. The Bureau of Indian Affairs (BIA) uses the information provided through these forms, approved under OMB# 1076-0157, to issue and administer grazing permits on Indian trust lands under the regulations at 25 CFR 166. Individuals seeking grazing permits provide information such as: name, address, phone number, number of livestock owned, type of livestock, class of livestock, season of use, brand information, brand ownership, brand location, grazing fee bid information, range improvement location and value, and information relating to permit violations or livestock trespass.
1076-0160	BIA 4432 - Verification of Indian Preference for Employment (PDF)	Applicants seeking employment in the Indian Health Service and/or Indian Affairs use this form to establish evidence of Indian preference as part of the application process. The Family History Chart is also used as part of the Indian Preference verification process.
1076-0160	1076-0160		Family History Chart (PDF)	Applicants seeking employment in the Indian Health Service and/or Indian Affairs use this form to establish evidence of Indian preference as part of the application process. The Family History Chart is also used as part of the Indian Preference verification process.
1076-0162	Navajo Partitioned Lands: Grazing Permits (Form 5-5015)	This information is used by the Department of the Interior (DOI), Bureau of Indian Affairs (BIA), and the Navajo Nation to determine eligibility for a Navajo Partitioned Land (NPL) grazing permit and to administer permits once issues. Information is submitted by individual Navajo tribal members wanting to obtain or modify a grazing permit and by departments and officials of the Navajo Nation.
1076-0162	1076-0162		Navajo Partitioned Lands: Modification of Grazing Permit (Form 5-5022)	This information is used by the Department of the Interior (DOI), Bureau of Indian Affairs (BIA), and the Navajo Nation to determine eligibility for a Navajo Partitioned Land (NPL) grazing permit and to administer permits once issues. Information is submitted by individual Navajo tribal members wanting to obtain or modify a grazing permit and by departments and officials of the Navajo Nation.
1076-0164	Authorization for Medical Care of a Minor	This is a BIE form which gives permission for a physician, surgeon, or dentist to provide necessary care to a child whose parents are not immediately available.
1076-0176	IDEIA Tribal Count Data Requirements for Part B
1076-0176	1076-0176		IDEIA Tribal Count Data Requirements Part C
1076-0179	BIE Advisory Board for Exceptional Education Membership Nomination Form	This form is used to submit nominations for individuals to serve on the Federal advisory committee, the Advisory Board for Exceptional Children.
1076-0180	Application for Permit to Drill Environmental Assessment Questionnaire	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form 139 - Application for Permit to Drill or Reenter	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form 208 - Well Completion or Recompletion Report and Log	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form 229 - Waterflood Operating Report	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form A - Osage Gas Mining Lease	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form B - Osage Oil Mining Lease	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form C - Osage Oil and Gas Mining Lease	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form D - Osage Mining Leases Bond	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form E - Evidence of Authority of Officers to Execute Papers	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form F - Assignment of Lease Form	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form G - Osage Mining Leases Collective Bond	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form H - Bond to Accompany Assignment of Mining Leases of Osage Lands	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Monthly Accounting Forms (Osage Form No. 133, 157, 300, 101 & 101A)	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Assignment of Liability Form	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Easement for Saltwater Disposal Well	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Lease Status Report (Unplugged Wells Only)	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Mineral Reserve Trucking Permit	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Mining Lease Modification Form	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Spill Reporting and Remediation Form	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Tank Bottom Oil Report	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Template Letter for List of Corporate Officers	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
1076-0181	Right-of-Way Application	This application is a request for the BIA to grant a right-of-way to cross land held in trust or restricted status on behalf of individual Indians and tribes under the terms and provisions of 25 U.S.C. 323-328 and 25 CFR 169. Please use Standard Form (SF)-299 for rights-of-way on Federal land.
1076-0183	Secretarial Election Voter Registration Form	This form is used by Tribal members to register in an upcoming Secretarial election as authorized by the Secretary of the Department of the Interior (or his/her designee) to adopt, amend, or revoke a Tribal constitution or a charter of incorporation issued under Federal statute. (in Word) *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
1076-0184	HIP GPRA Form (in Excel)	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
	1076-0184		HIP Housing Assistance Application (BIA 6407)	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
	1076-0184		HIP Housing Assistance Application Instructions	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
	1076-0184		Tribal Annual Performance Report (TAPR) - macro-enabled (in Excel)	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
	1076-0184		Tribal Annual Performance Report (TAPR) - non-macro enabled (manual entry only) (in Excel)	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
1076-0188	Self-Certification of Appraiser Qualifications	An appraiser may complete this self-certification if they meet the criteria in 43 CFR § 100.200.
1076-0190	Child Protection Safety Annual Report	The Highway Safety Act of 1966, 23 U.S.C. § 402, provides the Bureau of Indian Affairs (BIA), Office of Justice Services (OJS), Indian Highway Safety Program (IHSP) through the U.S. Department of Transportation (DOT), funding to assist federally recognized tribes in implementing traffic safety projects. Tribes receiving grant awards are required to submit a monthly progress report, including a Request for Reimbursement (RFR) with supporting documentation. The spreadsheet tabulates the data from one month to the next as statistics are entered, and eventually carried into the Annual Report. The spreadsheet was designed to assist the tribes in compiling the data reported on a monthly basis to reduce the tribe’s burden in completing the report at the end of the grant year.
	1076-0190		Child Protection Safety Monthly Report	The Highway Safety Act of 1966, 23 U.S.C. § 402, provides the Bureau of Indian Affairs (BIA), Office of Justice Services (OJS), Indian Highway Safety Program (IHSP) through the U.S. Department of Transportation (DOT), funding to assist federally recognized tribes in implementing traffic safety projects. Tribes receiving grant awards are required to submit a monthly progress report, including a Request for Reimbursement (RFR) with supporting documentation. The spreadsheet tabulates the data from one month to the next as statistics are entered, and eventually carried into the Annual Report. The spreadsheet was designed to assist the tribes in compiling the data reported on a monthly basis to reduce the tribe’s burden in completing the report at the end of the grant year.
	1076-0190		Law Enforcement Grant Monthly and Annual Report	The Highway Safety Act of 1966, 23 U.S.C. § 402, provides the Bureau of Indian Affairs (BIA), Office of Justice Services (OJS), Indian Highway Safety Program (IHSP) through the U.S. Department of Transportation (DOT), funding to assist federally recognized tribes in implementing traffic safety projects. Tribes receiving grant awards are required to submit a monthly progress report, including a Request for Reimbursement (RFR) with supporting documentation. The spreadsheet tabulates the data from one month to the next as statistics are entered, and eventually carried into the Annual Report. The spreadsheet was designed to assist the tribes in compiling the data reported on a monthly basis to reduce the tribe’s burden in completing the report at the end of the grant year.
1076-0195	Land Mortgage Lender Loan Checklist	These forms are used as part of the mortgage process, as described in 52 IAM 4-H. These documents are in Word only.
1076-0195	1076-0195		Leasehold Mortgage Lender Checklist	These forms are used as part of the mortgage process, as described in 52 IAM 4-H. These documents are in Word only.

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