Information Collection

Application for Permit to Modify (APM/revised APM) - 250.460;465;518(f);619(f);701-738;1704(g)

IC 211646 under ICR 201905-1014-009 · OMB 1014-0028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1014-0028 can be found here:

Documents and Forms

Document Name Document Type
Form BSEE-0124 Application for Permit to Modify (APM/revised APM) - 250.460;465;518(f);619(f);701-738;1704(g) Form and Instruction
eWell_Form-124_screens 2013.pdf ewell.bsee.gov/ewell/ Other-eWell Screenshots
aaa - PRA Statement for eWell as of 10-6-14.docx ewell.bsee.gov/ewell/ Other-PRA Statement for eWell
BSEE-0124 Application for Permit to Modify (APM) Form 0124 for APM ICR exp 2017.xlsx www.bsee.gov/About-BSEE/Doing-Business-with-BSEE/OCS-Operation-Forms/index/ Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Permit to Modify (APM/revised APM) - 250.460;465;518(f);619(f);701-738;1704(g)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.460;465;518(f);619(f) 30 CFR 250.701-738; 1704(g)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BSEE-0124	Application for Permit to Modify (APM)	Form 0124 for APM ICR exp 2017.xlsx	http://www.bsee.gov/About-BSEE/Doing-Business-with-BSEE/OCS-Operation-Forms/index/	Yes	Yes	Fillable Fileable
Other-eWell Screenshots			eWell_Form-124_screens 2013.pdf	https://ewell.bsee.gov/ewell/	Yes	No	Printable Only
Other-PRA Statement for eWell			aaa - PRA Statement for eWell as of 10-6-14.docx	https://ewell.bsee.gov/ewell/	Yes	No	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,893	Number of Respondents for Small Entity: 1,996

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

Percentage of Respondents Reporting Electronically: 85 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-2,893	2,893
Annual IC Time Burden (Hours)	-4,340	4,340
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.