Request for Approval for Royalty-Free Uses On-Lease or Off-Lease

Production Subject to Royalties, and Resource Conservation (43 CFR parts 3160 and 3170)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1004-0211 can be found here:

Documents and Forms

Document Name Document Type
Form 3160-5 Request for Approval for Royalty-Free Uses On-Lease or Off-Lease Form and Instruction
3160-5 Sundry Notices and Reports on Wells Form 3160-005 SUNDRY NOTICES AND REPORTS ON WELLS (OMB No. 1004-0137).pdf www.blm.gov/noc/st/en/business/eForms.html Form and Instruction
3160-5 Sundry Notices and Reports on Wells Form 3160-005 SUNDRY NOTICES AND REPORTS ON WELLS (OMB No. 1004-0137).pdf www.blm.gov/noc/st/en/business/eForms.html Form and Instruction

Information Collection (IC) Details

IC Title:	Request for Approval for Royalty-Free Uses On-Lease or Off-Lease	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 3178.9 43 CFR 3178.7 43 CFR 3178.5

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3160-5	Sundry Notices and Reports on Wells	Form 3160-005 SUNDRY NOTICES AND REPORTS ON WELLS (OMB No. 1004-0137).pdf	http://www.blm.gov/noc/st/en/business/eForms.html	Yes	Yes	Fillable Printable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 49

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	400	400
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.