File Attachment
1076-0160_family-history-form_expires-10.31.24_508_0.pdfType of Form
IA Paperwork Reduction Act (PRA) FormsOMB Control Number
1076-0160IA Internal Use Only
NoApplicants 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.