Information Collection

request for loan guaranty, insurance and/or interest subsidy

IC 178443 under ICR 200611-1076-003 · OMB 1076-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0020 can be found here:

Documents and Forms

Document Name Document Type
Form 5-4755 request for loan guaranty, insurance and/or interest subsidy Form
5-4755 Request to BIA for Loan Guaranty, Loan Insurance, and/or 0K5-4755REQUESTforLOANGUARANTYINSURANCEInterestSubsidy11.9.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	request for loan guaranty, insurance and/or interest subsidy	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 25 CFR 103.13 25 CFR 103.14 25 CFR 103.12 25 CFR 103.21

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5-4755	Request to BIA for Loan Guaranty, Loan Insurance, and/or Interest Subsidy	0K5-4755REQUESTforLOANGUARANTYINSURANCEInterestSubsidy11.9.pdf		No		Paper Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	130	130
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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