Information Collection

Subparts A, C, D, E, G, H, P - Actual APD and Supplemental APD

IC 225271 under ICR 201905-1014-004 · OMB 1014-0025.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1014-0025 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BSEE-0123 Subparts A, C, D, E, G, H, P - Actual APD and Supplemental APD	Form
eWell_Form-123_screens 2017.pdf	Other-Screen Shots from eWell
eWell_Form-123S_screens 2017.pdf	Other-Screen Shots for eWell
PAPERWORK REDUCTION ACT STATEMENT for eWell 2017.docx	Other-PRA Statement for eWell
BSEE-0123 Application for Permit to Drill (APD) Form 0123 exp 2017 for APD IC update.xlsx www.bsee.gov/sites/bsee.gov/files/reports/reports/form0123-exp-2017-for-apd-ic.pdf	Form
BSEE-0123s Supplemental APD Form 0123s for APD ICR exp 2017 update.xlsx www.bsee.gov/sites/bsee.gov/files/reports/reports/form123s-for-apd-icr-exp-2017.pdf	Form

IC Title:

Subparts A, C, D, E, G, H, P - Actual APD and Supplemental APD

Agency IC Tracking Number:

1014-0025 '19

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

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

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	BSEE-0123	Application for Permit to Drill (APD)	Form 0123 exp 2017 for APD IC update.xlsx	https://www.bsee.gov/sites/bsee.gov/files/reports/reports/form0123-exp-2017-for-apd-ic.pdf	Yes	Yes	Fillable Fileable Signable
Form	BSEE-0123s	Supplemental APD	Form 0123s for APD ICR exp 2017 update.xlsx	https://www.bsee.gov/sites/bsee.gov/files/reports/reports/form123s-for-apd-icr-exp-2017.pdf	Yes	Yes	Fillable Fileable Signable
Other-Screen Shots from eWell			eWell_Form-123_screens 2017.pdf		Yes	Yes	Fillable Fileable
Other-Screen Shots for eWell			eWell_Form-123S_screens 2017.pdf		Yes	Yes	Fillable Fileable
Other-PRA Statement for eWell			PAPERWORK REDUCTION ACT STATEMENT for eWell 2017.docx		Yes	Yes	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 408

Number of Respondents for Small Entity: 282

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	408	408
Annual IC Time Burden (Hours)	408	408
Annual IC Cost Burden (Dollars)	862,104	862,104

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.