Information Collection

11a(1); 40; 41 - Form BOEM-1016 - Designated Applicant Information Certification

IC 10801 under ICR 201306-1010-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form BOEM-1016 11a(1); 40; 41 - Form BOEM-1016 - Designated Applicant Information Certification Form
BOEM PRA 1016-1025-PRA-cover-sheet 2013 revised.docx www.boem.gov/BOEM-OCS-Operation-Forms/ Instruction
BOEM-1016 Designated Applicant Information Certificaton BOEM-1016 Designated Applicant 7-30-13.docx www.boem.gov/BOEM-OCS-Operation-Forms/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	11a(1); 40; 41 - Form BOEM-1016 - Designated Applicant Information Certification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 553.11a(1); 40; 41

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BOEM-1016	Designated Applicant Information Certificaton	BOEM-1016 Designated Applicant 7-30-13.docx	http://www.boem.gov/BOEM-OCS-Operation-Forms/	Yes	Yes	Fillable Printable
Instruction			BOEM PRA 1016-1025-PRA-cover-sheet 2013 revised.docx	http://www.boem.gov/BOEM-OCS-Operation-Forms/	Yes	Yes	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 140

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.