Information Collection

11a(1); 40; 41 - Form MMS-1016 - Designated Applicant Information

IC 10801 under ICR 200703-1010-005 · OMB 1010-0106.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1010-0106 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1016 11a(1); 40; 41 - Form MMS-1016 - Designated Applicant Information	Form
Form 1016a PRA cover sheet 4 OSFR.doc www.gomr.mms.gov/homepg/mmsforms/coversht.pdf	Other-PRA
1016 Designated Applicant Information Certification Form 1016 exp 10-10.doc www.gomr.mms.gov/homepg/mmsforms/mms1016.PDF	Form

IC Title:

11a(1); 40; 41 - Form MMS-1016 - Designated Applicant Information

Agency IC Tracking Number:

omm-1010-0106 ext 07

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 253.11a(1); 40; 41

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	1016	Designated Applicant Information Certification	Form 1016 exp 10-10.doc	http://www.gomr.mms.gov/homepg/mmsforms/mms1016.PDF	Yes	Yes	Fillable Fileable
Other-PRA			Form 1016a PRA cover sheet 4 OSFR.doc	http://www.gomr.mms.gov/homepg/mmsforms/coversht.pdf	Yes	No	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 140

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	-1,626	1,826
Annual IC Time Burden (Hours)	200	-19,099	19,299
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.