Lessee submits completed lease form

Leasing of Osage Reservation Lands for Oil and Gas Mining (25 CFR 226)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.