Information Collection

30 CFR 250, Subpart E, 250.513 and 516

IC 210273 under ICR 201402-1014-003 · OMB 1014-0025.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1014-0025 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
eWell_Form-123_screens 2013.pdf	Other-eWell Screen Shots
eWell_Form-123S_screens 2013.pdf	Other-eWell Screen Shots
PRA Statement for eWell.docx	Other-Revised PRA Statement for eWel

IC Title:

30 CFR 250, Subpart E, 250.513 and 516

Agency IC Tracking Number:

2014 - APDs

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.513 and 516

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-eWell Screen Shots	eWell_Form-123_screens 2013.pdf	Yes	Yes	Fillable Fileable
Other-eWell Screen Shots	eWell_Form-123S_screens 2013.pdf	Yes	Yes	Fillable Fileable
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: 880

Number of Respondents for Small Entity: 607

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	880	880
Annual IC Time Burden (Hours)	6,649	6,649
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.