Lessee submits applications for well drilling, treating, plugging, etc.

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⚠️ Notice: This information collection may be referencing outdated material.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 Form 139 Lessee submits applications for well drilling, treating, plugging, etc. Form
Form 139 Application to Drill or Reenter Form 139 - Permit to Drill or Reenter.docx Form
Easement Form Osage - Easement Form.docx Form
Notification of Well Spud Form Osage - Notification of Well Spud Form.doc Form
Seismic Permit Osage - Seismic Permit.docx Form

Information Collection (IC) Details

IC Title:	Lessee submits applications for well drilling, treating, plugging, etc.	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 226.34(b) 25 CFR 226.52

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form 139	Application to Drill or Reenter	Form 139 - Permit to Drill or Reenter.docx	Yes	Yes	Fillable Printable
Form	None	Easement Form	Osage - Easement Form.docx	Yes	Yes	Fillable Printable
Form	None	Notification of Well Spud Form	Osage - Notification of Well Spud Form.doc	Yes	Yes	Fillable Printable
Form	None	Seismic Permit	Osage - Seismic Permit.docx	Yes	Yes	Fillable Printable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	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	600	600
Annual IC Time Burden (Hours)	4,800	4,800
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.