Information Collection

Refinery Emergency Disruption and Incident Report

IC 187756 under ICR 200809-1910-007 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DOE-RefDisruptionInstructions-1-07-09rev.doc oe.netl.doe.gov	Instruction
OE-XXX Refinery Emergency Disruption and Incident Report DOE-RefDisruptionForm-1-07-09 rev.doc www.oe.netl.doe.gov	Form

IC Title:

Agency IC Tracking Number:

Alice Lippert

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

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
Instruction			DOE-RefDisruptionInstructions-1-07-09rev.doc	oe.netl.doe.gov	Yes	Yes	Fillable Printable
Form	OE-XXX	Refinery Emergency Disruption and Incident Report	DOE-RefDisruptionForm-1-07-09 rev.doc	www.oe.netl.doe.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	235	235
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.