Family History Chart

File Attachment

1076-0160_family-history-form_expires-10.31.24_508_0.pdf

Type of Form

IA Paperwork Reduction Act (PRA) Forms

OMB Control Number

1076-0160

IA Internal Use Only

No

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.