Information Collection

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

IC 225271 under ICR 201911-1014-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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 shots.pdf ewell.bsee.gov/ewell/controller?cmd=initlogin Other-BSEE-0123 Screen Shots
eWell_Form-123S_screens shots.pdf ewell.bsee.gov/ewell/controller?cmd=initlogin Other-BSEE-0123S Screen Shots
PAPERWORK REDUCTION ACT STATEMENT for eWell 2020.docx ewell.bsee.gov/ewell/controller?cmd=initlogin Other-eWell PRA Statement
BSEE-0123 Application for Permit to Drill Form 0123 exp 2020.xlsx www.bsee.gov/who-we-are/working-with-us/doing-business-bsee/OCS-forms Form
BSEE-0123S Supplemental APD Information Sheet Form 0123s exp 2020.xlsx www.bsee.gov/who-we-are/working-with-us/doing-business-bsee/OCS-forms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Subparts A, C, D, E, G, H, P - Actual APD and Supplemental APD	Agency IC Tracking Number:	1014-0025 '20

Is this a Common Form? No		IC Status: Modified

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:

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	Form 0123 exp 2020.xlsx	https://www.bsee.gov/who-we-are/working-with-us/doing-business-bsee/OCS-forms	Yes	Yes	Fillable Fileable
Form	BSEE-0123S	Supplemental APD Information Sheet	Form 0123s exp 2020.xlsx	https://www.bsee.gov/who-we-are/working-with-us/doing-business-bsee/OCS-forms	Yes	Yes	Fillable Fileable
Other-BSEE-0123 Screen Shots			eWell_Form-123_screens shots.pdf	https://ewell.bsee.gov/ewell/controller?cmd=initlogin	Yes	Yes	Fillable Fileable
Other-BSEE-0123S Screen Shots			eWell_Form-123S_screens shots.pdf	https://ewell.bsee.gov/ewell/controller?cmd=initlogin	Yes	Yes	Printable Only
Other-eWell PRA Statement			PAPERWORK REDUCTION ACT STATEMENT for eWell 2020.docx	https://ewell.bsee.gov/ewell/controller?cmd=initlogin	Yes	Yes	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 190	Number of Respondents for Small Entity: 131

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

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	190	-218	408
Annual IC Time Burden (Hours)	190	-218	408
Annual IC Cost Burden (Dollars)	401,470	-460,634	862,104

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.