Information Collection

250.192(b) - Initial Damage Report

IC 227523 under ICR 201701-1014-004 · OMB 1014-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1014-0022 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BSEE-0143 250.192(b) - Initial Damage Report	Form
eWell-Form-0143-FacilityDamage - screen shots.docx ewell.bsee.gov/ewell/	Other-eWell Screen Shots
BSEE-0143 FACILITY/EQUIPMENT DAMAGE REPORT Form 0143 exp 2017.doc www.bsee.gov/sites/bsee.gov/files/reports/reports/form143-exp-2017.pdf	Form

IC Title:

250.192(b) - Initial Damage Report

Agency IC Tracking Number:

1014-0022 '17

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.192(b)

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
Form	BSEE-0143	FACILITY/EQUIPMENT DAMAGE REPORT	Form 0143 exp 2017.doc	https://www.bsee.gov/sites/bsee.gov/files/reports/reports/form143-exp-2017.pdf	Yes	Yes	Fillable Fileable
Other-eWell Screen Shots			eWell-Form-0143-FacilityDamage - screen shots.docx	https://ewell.bsee.gov/ewell/	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4

Number of Respondents for Small Entity: 3

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	4	4
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.