Information Collection

Request for Approval for Royalty-Free Uses On-Lease or Off-Lease

IC 219329 under ICR 201705-1004-001 · OMB 1004-0211.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1004-0211 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3160-5 Request for Approval for Royalty-Free Uses On-Lease or Off-Lease	Form and Instruction
3160-5 Sundry Notices and Reports on Wells Sundry Notice, Form 3160-5.pdf www.blm.gov/noc/st/en/business/eForms.html	Form and Instruction

IC Title:

Request for Approval for Royalty-Free Uses On-Lease or Off-Lease

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 43 CFR 3178.5 43 CFR 3178.7 43 CFR 3178.9 43 CFR 3178.8

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 and Instruction	3160-5	Sundry Notices and Reports on Wells	Sundry Notice, Form 3160-5.pdf	http://www.blm.gov/noc/st/en/business/eForms.html	Yes	Yes	Fillable Printable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 49

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	200	200
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.