153 Notification of P/L Installation/Relocation/Hydrotest

U.S. Department of the Interior Appendix A OMB Control Number 1010-xxxx

Minerals Management Service OMB Approval Expires xx/xx/xxxx

Notification of Pipeline Installation/Relocation/Hydrotest

Segment Number:

Date:

Report Provided By:

Name:

Phone:

Company:

Pipeline Installation

Installation/Relocation Start Date:

Construction Vessel Name:

Telephone and/or Radio Frequency:

Heliport Location:

From:

Structure:

To:

Structure:

Area:

Area:

Block:

Block:

Initial Construction Location:

Estimated Time to Complete Activity:

For Internal Use Only

District Notified:

Time and Date:

Person Contacted:

Date of Inspection:

Date Inspection Report Received:

Pipeline Hydrostatic Pressure Test

Date of Test:

Location of Recorder:

Location of Heliport:

For Internal Use Only

District Notified:

Time and Date:

Person Contacted:

Date of Inspection:

Date Inspection Report Received:

Paperwork Reduction Act (PRA): The PRA (44 U.S.C. 3504 et seq.) requires us to inform you that MMS collects this information to carry out its responsibilities under the OCS Lands Act, as amended. MMS will use the information to evaluate the effectiveness of industry’s continued improvement of safety and environmental management in the OCS. No proprietary data are collected. We estimate the public reporting burden, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the information to average 1 hour per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control number. The OMB has approved this collection of information and assigned OMB Control Number 1010-xxxx. You may direct comments regarding the burden estimate or any other aspect of this collection of information to the Information Collection Clearance Officer, Mail Stop 4230, Minerals Management Service, Department of the Interior, 1849 C Street, NW, Washington, DC 20240

MMS Form MMS-153 (Mo/Year) Page 1 of 1