Information Collection

250.721(g)(5) - Test Results

IC 234286 under ICR 201811-1014-001 · OMB 1014-0028.

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IC Title:	250.721(g)(5) - Test Results	Agency IC Tracking Number:	1014-0028 '19

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.721(g)(5)

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: 1,340	Number of Respondents for Small Entity: 925

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

Percentage of Respondents Reporting Electronically: 90 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,340	1,340
Annual IC Time Burden (Hours)	1,005	1,005
Annual IC Cost Burden (Dollars)	0	0

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