Information Collection

250.1151 Form MMS-128

IC 46343 under ICR 200612-1010-001 · OMB 1010-0041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1010-0041 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 128 250.1151 Form MMS-128	Form
128 Semiannual Well Test Report Form 128 exp 8-08.doc www.gomr.mms.gov/homepg/mmsforms/FormMMS-128.pdf	Form

IC Title:

250.1151 Form MMS-128

Agency IC Tracking Number:

OMM-1010-0041 re AD12

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.1151

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	128	Semiannual Well Test Report	Form 128 exp 8-08.doc	http://www.gomr.mms.gov/homepg/mmsforms/FormMMS-128.pdf	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 130

Number of Respondents for Small Entity: 91

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	13,600	13,600
Annual IC Time Burden (Hours)	1,336	1,336
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.