Information Collection

Letter from medical services provider, 25 CFR 175

IC 255987 under ICR 202208-1076-002 · OMB 1076-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0021 can be found here:

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Information Collection (IC) Details

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IC Title:	Letter from medical services provider, 25 CFR 175	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 175.130

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Energy

Subfunction: Energy Supply

Privacy Act System of Records
Title: BIA-26--Indian Electric Power Utilities	FR Citation: 52 FR 43401

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

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