Information Collection

250.1304(e) - 3 copies of transcript

IC 228724 under ICR 201701-1014-006 · OMB 1014-0015.

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IC Title:	250.1304(e) - 3 copies of transcript	Agency IC Tracking Number:	1014-0015 ext. 17

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 30 CFR 250.1304(e)

Information Collection 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: 1	Number of Respondents for Small Entity: 1

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	500	500

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