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Forms

NOTE: forms that are noted below as being in MS-Word or Excel format should be opened using Google Chrome (due to issues with Internet Explorer (IE) and Excel/Word)

Visit Indian Affairs Specific Forms and Guidance

OMB Control Number	Title	Description
1076-0180	Form G - Osage Mining Leases Collective Bond	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Form H - Bond to Accompany Assignment of Mining Leases of Osage Lands	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Monthly Accounting Forms (Osage Form No. 133, 157, 300, 101 & 101A)	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Assignment of Liability Form	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180			The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Lease Status Report (Unplugged Wells Only)	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Mineral Reserve Trucking Permit	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Mining Lease Modification Form	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Spill Reporting and Remediation Form	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Osage Tank Bottom Oil Report	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
	1076-0180		Template Letter for List of Corporate Officers	The United States holds the subsurface mineral estate in Osage County, Oklahoma (Osage Mineral Estate) in trust for the benefit of the Osage Nation. The regulations set forth in 25 CFR 226, implement that statute by specifying what information a lessee must provide related to drilling, development, and production of oil and gas on Osage reservation land. The BIA collects this information to administer the leasing and development of the Osage Mineral Estate as well as to ensure that all royalties and revenues derived from the Osage Mineral Estate are collected and accounted for and that the oil and gas trust assets, surface estate, natural resources, and human environment are adequately protected.
1076-0181	Right-of-Way Application	This application is a request for the BIA to grant a right-of-way to cross land held in trust or restricted status on behalf of individual Indians and tribes under the terms and provisions of 25 U.S.C. 323-328 and 25 CFR 169. Please use Standard Form (SF)-299 for rights-of-way on Federal land.
1076-0183	Secretarial Election Voter Registration Form	Under the Indian Reorganization Act, Tribes have the right to organize and adopt constitutions, bylaws, and any amendments thereto, and ratify charters of incorporation, through elections called by the Secretary of the Interior (Secretarial election). This form is used by Tribal members to register in an upcoming Secretarial election.
1076-0184	HIP Addendum	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
	1076-0184		HIP GPRA Form (in Excel)	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
	1076-0184		HIP Housing Assistance Application (BIA 6407)	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
	1076-0184		HIP Housing Assistance Application Instructions	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
	1076-0184		Tribal Annual Performance Report (TAPR) - macro-enabled (in Excel)	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
	1076-0184		Tribal Annual Performance Report (TAPR) - non-macro enabled (manual entry only) (in Excel)	Housing Improvement Program (HIP) forms *(note:* *please open any form noted as being in Excel or Word using Chrome (instead of Internet Explorer) due to issues with IE and Excel/Word docs)*
1076-0188	Self-Certification of Appraiser Qualifications	An appraiser may complete this self-certification if they meet the criteria in 43 CFR § 100.200.
1076-0190	Indian Highway Grant Application Instructions Indian Highway Safety Program – Annual Report, Monthly Report, Mobilization and Sustained Enforcement Form	The Highway Safety Act of 1966, 23 U.S.C. § 402, provides the Bureau of Indian Affairs (BIA), Office of Justice Services (OJS), Indian Highway Safety Program (IHSP) through the U.S. Department of Transportation (DOT), funding to assist federally recognized tribes in implementing traffic safety projects. Tribes receiving grant awards are required to submit a monthly progress report, including a Request for Reimbursement (RFR) with supporting documentation. The spreadsheet tabulates the data from one month to the next as statistics are entered, and eventually carried into the Annual Report. The spreadsheet was designed to assist the tribes in compiling the data reported on a monthly basis to reduce the tribe’s burden in completing the report at the end of the grant year.
	1076-0190		Child Passenger Safety Seat Program Grant	The Highway Safety Act of 1966, 23 U.S.C. § 402, provides the Bureau of Indian Affairs (BIA), Office of Justice Services (OJS), Indian Highway Safety Program (IHSP) through the U.S. Department of Transportation (DOT), funding to assist federally recognized tribes in implementing traffic safety projects. Tribes receiving grant awards are required to submit a monthly progress report, including a Request for Reimbursement (RFR) with supporting documentation. The spreadsheet tabulates the data from one month to the next as statistics are entered, and eventually carried into the Annual Report. The spreadsheet was designed to assist the tribes in compiling the data reported on a monthly basis to reduce the tribe’s burden in completing the report at the end of the grant year.
	1076-0190		Law Enforcement Grant Application	The Highway Safety Act of 1966, 23 U.S.C. § 402, provides the Bureau of Indian Affairs (BIA), Office of Justice Services (OJS), Indian Highway Safety Program (IHSP) through the U.S. Department of Transportation (DOT), funding to assist federally recognized tribes in implementing traffic safety projects. Tribes receiving grant awards are required to submit a monthly progress report, including a Request for Reimbursement (RFR) with supporting documentation. The spreadsheet tabulates the data from one month to the next as statistics are entered, and eventually carried into the Annual Report. The spreadsheet was designed to assist the tribes in compiling the data reported on a monthly basis to reduce the tribe’s burden in completing the report at the end of the grant year.
	1076-0190		Impaired Driving Adjudication Court Application	The Highway Safety Act of 1966, 23 U.S.C. § 402, provides the Bureau of Indian Affairs (BIA), Office of Justice Services (OJS), Indian Highway Safety Program (IHSP) through the U.S. Department of Transportation (DOT), funding to assist federally recognized tribes in implementing traffic safety projects. Tribes receiving grant awards are required to submit a monthly progress report, including a Request for Reimbursement (RFR) with supporting documentation. The spreadsheet tabulates the data from one month to the next as statistics are entered, and eventually carried into the Annual Report. The spreadsheet was designed to assist the tribes in compiling the data reported on a monthly basis to reduce the tribe’s burden in completing the report at the end of the grant year.
1076-0195	Land Mortgage Lender Loan Checklist	These forms are used as part of the mortgage process, as described in 52 IAM 4-H. These documents are in Word only.
1076-0195	1076-0195		Leasehold Mortgage Lender Checklist	These forms are used as part of the mortgage process, as described in 52 IAM 4-H. These documents are in Word only.

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