Information Collection

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

IC 179365 under ICR 201008-1010-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 MMS-1019 21-24; 26-27; 30; 40-41; 43 - Form MMS-1018 - Self-Insurance or Indemnity	Form
MMS-1019 Insurance Certificate Form 1019 exp 12-13.doc www.gomr.mms.gov/homepg/mmsforms/frmindx.html	Form

IC Title:

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

Agency IC Tracking Number:

1010-0106 ext 10

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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

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	MMS-1019	Insurance Certificate	Form 1019 exp 12-13.doc	http://www.gomr.mms.gov/homepg/mmsforms/frmindx.html	Yes	Yes	Fillable Printable

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 %

table that charts list of burden
	Approved	Previously Approved
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

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.