Information Collection

250.1151(a)(1), (c); 250.1167 - BSEE-0126 Form

IC 234571 under ICR 201807-1014-007 · OMB 1014-0019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1014-0019 can be found here:

Documents and Forms

Document Name Document Type
Form BSEE-0126 250.1151(a)(1), (c); 250.1167 - BSEE-0126 Form Form and Instruction
BSEE-0126 Well Potential Test Report Form 0126 exp 2019.docx www.bsee.gov/who-we-are/working-with-us/doing-business-bsee/OCS-forms Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	250.1151(a)(1), (c); 250.1167 - BSEE-0126 Form	Agency IC Tracking Number:	1014-0019 '19

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.1151(a)(1), (c); 250.1167

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BSEE-0126	Well Potential Test Report	Form 0126 exp 2019.docx	https://www.bsee.gov/who-we-are/working-with-us/doing-business-bsee/OCS-forms	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 236	Number of Respondents for Small Entity: 163

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

Percentage of Respondents Reporting Electronically: 30 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	236	236
Annual IC Time Burden (Hours)	1,239	1,239
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.