Information Collection

Subparts A, C, D, E, G, H, P - Actual APD and Supplemental APD

IC 225271 under ICR 201612-1014-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form BSEE-0123 Subparts A, C, D, E, G, H, P - Actual APD and Supplemental APD Form
eWell_Form-123_screens 2017.pdf Other-Screen Shots from eWell
eWell_Form-123S_screens 2017.pdf Other-Screen Shots for eWell
PAPERWORK REDUCTION ACT STATEMENT for eWell 2017.docx Other-PRA Statement for eWell
BSEE-0123 Application for Permit to Drill (APD) Form 0123 exp 2017 for APD IC update.xlsx www.bsee.gov/sites/bsee.gov/files/reports/reports/form0123-exp-2017-for-apd-ic.pdf Form
BSEE-0123s Supplemental APD Form 0123s for APD ICR exp 2017 update.xlsx www.bsee.gov/sites/bsee.gov/files/reports/reports/form123s-for-apd-icr-exp-2017.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Subparts A, C, D, E, G, H, P - Actual APD and Supplemental APD	Agency IC Tracking Number:	1014-0025 '17

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR Subparts A, C, D, E, G, H, P (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BSEE-0123	Application for Permit to Drill (APD)	Form 0123 exp 2017 for APD IC update.xlsx	https://www.bsee.gov/sites/bsee.gov/files/reports/reports/form0123-exp-2017-for-apd-ic.pdf	Yes	Yes	Fillable Fileable Signable
Form	BSEE-0123s	Supplemental APD	Form 0123s for APD ICR exp 2017 update.xlsx	https://www.bsee.gov/sites/bsee.gov/files/reports/reports/form123s-for-apd-icr-exp-2017.pdf	Yes	Yes	Fillable Fileable Signable
Other-Screen Shots from eWell			eWell_Form-123_screens 2017.pdf		Yes	Yes	Fillable Fileable
Other-Screen Shots for eWell			eWell_Form-123S_screens 2017.pdf		Yes	Yes	Fillable Fileable
Other-PRA Statement for eWell			PAPERWORK REDUCTION ACT STATEMENT for eWell 2017.docx		Yes	Yes	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 408	Number of Respondents for Small Entity: 282

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	408	408
Annual IC Time Burden (Hours)	408	408
Annual IC Cost Burden (Dollars)	862,104	862,104

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.