Information Collection

Abandoned Mine Land Contractor Information Form - Industry

IC 11417 under ICR 202104-1029-004 · OMB 1029-0119.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1029-0119 can be found here:

Documents and Forms

Document Name Document Type
Abandoned Mine Land Contractor Information Form - Industry Form
Final 04212021 OMB1029-0119 instructions.pdf www.osmre.gov/programs/AVS.shtm Instruction
AML Contractor Information Form Final 04212021 AML Contractor Information Form 202X.pdf www.osmre.gov/programs/AVS.shtm Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Abandoned Mine Land Contractor Information Form - Industry	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 30 CFR 874.16

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	AML Contractor Information Form	Final 04212021 AML Contractor Information Form 202X.pdf	https://www.osmre.gov/programs/AVS.shtm	Yes	Yes	Fillable Printable
Instruction			Final 04212021 OMB1029-0119 instructions.pdf	https://www.osmre.gov/programs/AVS.shtm	Yes	No	Printable Only

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 177	Number of Respondents for Small Entity: 177

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	177	17	160
Annual IC Time Burden (Hours)	85	7	78
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.