Abandoned Mine Land Contractor Information Form - Industry

Instructions for Completing AML Contractor Form OMB #1029-01191
Part A: General Information. Part A should be completed by the AML Contractor.

Part B: Legal Structure. Part B should be completed by the AML Contractor.

Part C: Certifying and updating information in the Applicant/Violator System (AVS). Part C should
be completed by the AML Contractor, selecting the statement that best describes their situation.

If information is accurate, complete and up-to-date, then check the first statement and sign and date.
Attach the Entity OFT printout to the OMB #1029-0119 form and submit the form and attachment to
the AML Contracting Officer your business is working with. 2
Upon reviewing an Entity OFT printout, if you discover the information contained in AVS is not
accurate, complete and up-to-date, then check the second statement and complete Part D to provide
missing or corrected information that needs reflected in AVS. Attach the Entity OFT printout to the
OMB #1029-0119 form and submit the form and attachment to the AML Contracting Officer your
business is working with.
If your business does not appear to have any information in AVS, then check the third statement and
complete Part D. Submit the OMB #1029-0119 form to the AML Contracting Officer your business is
working with.
Part D:

If current Entity OFT information for your business is incomplete, incorrect, or if you believe there
is no information currently in the AVS for your business, you must complete Part D. Submit the
OMB #1029-0119 form to the AML Contracting Officer your business is working with.

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If you need any assistance completing OMB #1029-0119, please contact the AVS Office at 800.643.9748.
You may obtain your business’ Entity OFT for certification purposes two ways. One way is to contact the AVS Office at
800.643.9748 and request the information. The second way is to access the AVS from your personal computer by visiting
https://avss.osmre.gov. Click “Access AVS”, and then Login as Guest. Place your cursor on the “Entity” Module and
“Click”. Type your business name in search box and press enter key. If more than one entity record appears, select your
company and then “Click” on the “relationship” tab to display your Entity OFT information. Print the Entity OFT from AVS.
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