Information Collection

250.1151(a)(1), (c); 250.1167 - BSEE-0126 Form

IC 234571 under ICR 202112-1014-001 · OMB 1014-0019.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BSEE-0126 250.1151(a)(1), (c); 250.1167 - BSEE-0126 Form	Form
BSEE-0126 WELL POTENTIAL TEST REPORT (WPT) Form 0126 exp 2023.docx www.bsee.gov/who-we-are/working-with-us/OCS-forms	Form

IC Title:

Agency IC Tracking Number:

1014-0019 '22

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.1151(a)(1), (c); 250.1167

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	BSEE-0126	WELL POTENTIAL TEST REPORT (WPT)	Form 0126 exp 2023.docx	https://www.bsee.gov/who-we-are/working-with-us/OCS-forms	Yes	Yes	Fillable Fileable Signable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 154

Number of Respondents for Small Entity: 107

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	154	-82	236
Annual IC Time Burden (Hours)	809	-430	1,239
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.