Information Collection

291.105-6, 108-9, 111 Submit complaint; request confidential treatment

IC 44588 under ICR 201102-1010-001 · OMB 1010-0172.

Documents and Forms

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Document Name	Document Type

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IC Title:

291.105-6, 108-9, 111 Submit complaint; request confidential treatment

Agency IC Tracking Number:

291.105-6, 108-9, 111

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 30 CFR 291.105-6, 108-9, 111

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

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	-4	5
Annual IC Time Burden (Hours)	50	-200	250
Annual IC Cost Burden (Dollars)	7,500	-30,000	37,500

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.