11(a)(2) Form BOEM-1025 - Independent Designated Applicant Information Certification

30 CFR 553, Oil Spill Financial Responsibility for Offshore Facilities

⚠️ Notice: This information collection may be referencing outdated material.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-1025 11(a)(2) Form BOEM-1025 - Independent Designated Applicant Information Certification Form
BOEM-1025 Independent Designated Applicant Information Certificati BOEM-1025New Independent Designated Applicant 7-30-13 .docx www.boem.gov/BOEM-OCS-Operation-Forms/ Form

Information Collection (IC) Details

IC Title:	11(a)(2) Form BOEM-1025 - Independent Designated Applicant Information Certification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 553.11(a)(2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BOEM-1025	Independent Designated Applicant Information Certification	BOEM-1025New Independent Designated Applicant 7-30-13 .docx	http://www.boem.gov/BOEM-OCS-Operation-Forms/	Yes	Yes	Fillable Printable

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: 120

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

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Program Change Due to Agency Discretion
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
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.