Subparts D, E, F, G, H, P, Q - APM Application

Application for Permit to Modify(APM) and supporting documentation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1014-0026 can be found here:

Documents and Forms

Document Name Document Type
Form BSEE-0124 Subparts D, E, F, G, H, P, Q - APM Application Form
eWell_Form-124_screens shots 2017.pdf Other-Screen Shots
PAPERWORK REDUCTION ACT STATEMENT for eWell 2017.docx Other-eWell PRA Statement
BSEE-0124 Application for Permit to Modify Form 0124 for APM ICR exp 2017 additional questions.xlsx Form

Information Collection (IC) Details

IC Title:	Subparts D, E, F, G, H, P, Q - APM Application	Agency IC Tracking Number:	1014-0026 APM '17

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 30 CFR Subparts D, E, F, G, H, P, Q (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BSEE-0124	Application for Permit to Modify	Form 0124 for APM ICR exp 2017 additional questions.xlsx	Yes	Yes	Fillable Fileable Signable
Other-Screen Shots			eWell_Form-124_screens shots 2017.pdf	Yes	Yes	Fillable Fileable Signable
Other-eWell PRA Statement			PAPERWORK REDUCTION ACT STATEMENT for eWell 2017.docx	Yes	No	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,468	Number of Respondents for Small Entity: 1,703

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

Percentage of Respondents Reporting Electronically: 99 %

	Requested	Previously Approved
Annual Number of Responses for this IC	2,468	2,468
Annual IC Time Burden (Hours)	2,468	2,468
Annual IC Cost Burden (Dollars)	308,500	308,500

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.