Notification of Change of Operator and Assumption of Past Liability (43 CFR 3809.116)

Surface Management Activities under the General Mining Law (43 CFR Subpart 3809)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1004-0194 can be found here:

Documents and Forms

Document Name Document Type
Form 3809-005 Notification of Change of Operator and Assumption of Past Liability (43 CFR 3809.116) Form
3809-005 Notification of Change of Operator and Assumption of Pas 3809-005.docx www.blm.gov/services/electronic-forms Form

Information Collection (IC) Details

IC Title:	Notification of Change of Operator and Assumption of Past Liability (43 CFR 3809.116)	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 3809.116

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3809-005	Notification of Change of Operator and Assumption of Past Liability	3809-005.docx	https://www.blm.gov/services/electronic-forms	Yes	Yes	Fillable Printable

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 42

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	416	416
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.