Information Collection

1000.173 - Request to negotiate a FA

IC 190036 under ICR 201903-1076-007 · OMB 1076-0143.

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Information Collection (IC) Details

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IC Title:	1000.173 - Request to negotiate a FA	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 25 CFR 1000.173

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: 5	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 30 %

	Approved	Previously Approved
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	100	100

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