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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.