Information Collection

250.180(e), (j) - Request +180 days

IC 227514 under ICR 201701-1014-004 · OMB 1014-0022.

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IC Title:

250.180(e), (j) - Request +180 days

Agency IC Tracking Number:

1014-0022 '17

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 30 CFR 250.180(e), (j)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 2

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

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