Information Collection

Application for Permit to Modify (APM/revised APM) - 250.460;465;518(f);619(f);701-738;1704(g)

IC 211646 under ICR 201301-1014-002 · OMB 1014-0028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1014-0028 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BSEE-0124 Application for Permit to Modify (APM/revised APM) - 250.460;465;518(f);619(f);701-738;1704(g)	Form and Instruction
eWell_Form-124_screens 2013.pdf ewell.bsee.gov/ewell/	Other-eWell Screenshots
aaa - PRA Statement for eWell as of 10-6-14.docx ewell.bsee.gov/ewell/	Other-PRA Statement for eWell
BSEE-0124 Application for Permit to Modify (APM) Form 0124 for APM ICR exp 2017.xlsx www.bsee.gov/About-BSEE/Doing-Business-with-BSEE/OCS-Operation-Forms/index/	Form and Instruction

IC Title:

Application for Permit to Modify (APM/revised APM) - 250.460;465;518(f);619(f);701-738;1704(g)

Agency IC Tracking Number:

1014-NEW AA11

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.460;465;518(f);619(f) 30 CFR 250.701-738; 1704(g)

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 and Instruction	BSEE-0124	Application for Permit to Modify (APM)	Form 0124 for APM ICR exp 2017.xlsx	http://www.bsee.gov/About-BSEE/Doing-Business-with-BSEE/OCS-Operation-Forms/index/	Yes	Yes	Fillable Fileable
Other-eWell Screenshots			eWell_Form-124_screens 2013.pdf	https://ewell.bsee.gov/ewell/	Yes	No	Printable Only
Other-PRA Statement for eWell			aaa - PRA Statement for eWell as of 10-6-14.docx	https://ewell.bsee.gov/ewell/	Yes	No	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,444

Number of Respondents for Small Entity: 3,066

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,444	4,444
Annual IC Time Burden (Hours)	13,250	13,250
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.