Information Collection

Electrical Power Service Application, 25 CFR 175

IC 43768 under ICR 202508-1076-003 · OMB 1076-0021.

Documents and Forms

Document Name Document Type
Electric Service Application Electrical Power Service Application, 25 CFR 175 Form and Instruction
Electric Service Application 1076-0021 Application for Electrical Service 08-31-2022.pdf www.bia.gov/policy-forms/online-forms Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Electrical Power Service Application, 25 CFR 175	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 175

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Electric Service Application	1076-0021 Application for Electrical Service 08-31-2022.pdf	https://www.bia.gov/policy-forms/online-forms	Yes	Yes	Fillable Fileable

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: 1,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,300	1,300
Annual IC Time Burden (Hours)	650	650
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.

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