Information Collection

250.192(b) - Initial Damage Report

IC 227523 under ICR 202005-1014-002 · OMB 1014-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1014-0022 can be found here:

Documents and Forms

Document Name Document Type
Form BSEE-0143 250.192(b) - Initial Damage Report Form and Instruction
eWell-Form-0143-FacilityDamage - screen shots.docx ewell.bsee.gov/ewell/ Other-screen shots
BSEE-0143 FACILITY/EQUIPMENT DAMAGE REPORT Form 0143 exp 2020.docx www.bsee.gov/who-we-are/working-with-us/doing-business-bsee/OCS-forms Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	250.192(b) - Initial Damage Report	Agency IC Tracking Number:	1014-0022 '20

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.192(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BSEE-0143	FACILITY/EQUIPMENT DAMAGE REPORT	Form 0143 exp 2020.docx	https://www.bsee.gov/who-we-are/working-with-us/doing-business-bsee/OCS-forms	Yes	Yes	Fillable Fileable
Other-screen shots			eWell-Form-0143-FacilityDamage - screen shots.docx	https://ewell.bsee.gov/ewell/	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4	Number of Respondents for Small Entity: 3

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

Percentage of Respondents Reporting Electronically: 95 %

	Requested	Previously Approved
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	12	12
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.