Information Collection

21-24; 26-27; 30; 40-41; 43 - Form MMS-1018 - Self-Insurance or Indemnity

IC 179365 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1018 21-24; 26-27; 30; 40-41; 43 - Form MMS-1018 - Self-Insurance or Indemnity Form
1018 Self-Insurance or Indemnity Information Form 1018 exp 10-10.doc www.gomr.mms.gov/homepg/mmsforms/mms1018.PDF Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	21-24; 26-27; 30; 40-41; 43 - Form MMS-1018 - Self-Insurance or Indemnity	Agency IC Tracking Number:	omm-1010-0106 ext 07

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 253.21-24; 26-27; 30; 40-41;43

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1018	Self-Insurance or Indemnity Information	Form 1018 exp 10-10.doc	http://www.gomr.mms.gov/homepg/mmsforms/mms1018.PDF	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 52

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.