Information Collection

250.1151(a)(2), (c); 250.1167 - BSEE-0128 form

IC 234572 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form BSEE-0128 250.1151(a)(2), (c); 250.1167 - BSEE-0128 form	Form and Instruction
BSEE-0128 Semiannual Well Test Report Form 0128 exp 2019.docx www.bsee.gov/who-we-are/working-with-us/doing-business-bsee/OCS-forms	Form and Instruction

IC Title:

250.1151(a)(2), (c); 250.1167 - BSEE-0128 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)(2), (c); 250.1167

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	BSEE-0128	Semiannual Well Test Report	Form 0128 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: 6,018

Number of Respondents for Small Entity: 4,153

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	6,018	6,018
Annual IC Time Burden (Hours)	24,072	24,072
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.