Information Collection

30, CFR 250, Subpart H; 250.801 and 807

IC 210258 under ICR 201402-1014-002 · OMB 1014-0026.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1014-0026 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
eWell_Form-124_screens 2013.pdf	Other-actual screen shots
PRA Statement for eWell.docx	Other-Revised PRA Statement for eWel

IC Title:

30, CFR 250, Subpart H; 250.801 and 807

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.801 and 807

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
Other-actual screen shots			eWell_Form-124_screens 2013.pdf		Yes	No	Printable Only
Other-Revised PRA Statement for eWell			PRA Statement for eWell.docx		Yes	No	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 70

Number of Respondents for Small Entity: 48

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	19	19
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.