Information Collection

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

IC 225480 under ICR 201905-1014-008 · OMB 1014-0026.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
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

View Information Collection (IC)

layout table

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
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
Form BSEE-0124 Application for Permit to Modify Form 0124 for APM ICR exp 2017 additional questions.xlsx Yes Yes Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,468 0 0 0 0 2,468
Annual IC Time Burden (Hours) 2,468 0 0 0 0 2,468
Annual IC Cost Burden (Dollars) 308,500 0 0 0 0 308,500

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.