Information Collection

Lessee submits completed lease form

IC 206852 under ICR 201507-1076-001 · OMB 1076-0180.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0180 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Lease Form A Lessee submits completed lease form	Form
Lease Form A Gas Mining Lease Form A - Gas Mining Lease.doc	Form
Lease Form B Oil Mining Lease Form B - Osage Oil Lease.doc	Form
Lease Form C Oil & Gas Mining Lease Form Form C - Oil and Gas Lease.docx	Form
Form E Evidence of Authority Form E - Evidence of Authority.doc	Form
Lease Modification Form Osage - Modification Form.doc	Form

IC Title:

Lessee submits completed lease form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 25 CFR 226.5

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Lease Form A	Gas Mining Lease	Form A - Gas Mining Lease.doc	Yes	No	Fillable Printable
Form	Lease Form B	Oil Mining Lease	Form B - Osage Oil Lease.doc	Yes	Yes	Fillable Printable
Form	Lease Form C	Oil & Gas Mining Lease Form	Form C - Oil and Gas Lease.docx	Yes	Yes	Fillable Printable
Form	Form E	Evidence of Authority	Form E - Evidence of Authority.doc	Yes	No	Fillable Printable
Form	None	Lease Modification Form	Osage - Modification Form.doc	Yes	No	Fillable Printable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 160

Number of Respondents for Small Entity: 30

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	80	80
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.