Information Collection

BLM Facility Requirement Form

IC 235069 under ICR 202009-1004-004 · OMB 1004-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1004-0042 can be found here:

Documents and Forms

Document Name Document Type
Form 4710-24 BLM Facility Requirement Form Form
4710-24 Facility Requirement Form 4710-024-Facilities Certification Form (REVISED).pdf Form
4710-24 Facility Requirement Form 4710-024-Facilities Certification Form (REVISED).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	BLM Facility Requirement Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 43 CFR 4750.3-2

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4710-24	Facility Requirement Form	4710-024-Facilities Certification Form (REVISED).pdf		Yes	Yes	Fillable Fileable

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 450	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	450	0	450
Annual IC Time Burden (Hours)	225	148	77
Annual IC Cost Burden (Dollars)	0	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.