Information Collection

11a(1); 40; 41 - Form BOEM-1016 - Designated Applicant Information Certification

IC 10801 under ICR 202207-1010-001 · OMB 1010-0106.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BOEM-1016 11a(1); 40; 41 - Form BOEM-1016 - Designated Applicant Information Certification	Form
BOEM PRA 1016-1025-PRA-cover-sheet 2016 draft.docx www.boem.gov/BOEM-OCS-Operation-Forms/	Instruction
BOEM-1016 Designated Applicant Information Certificaton BOEM-1016 Designated Applicant_updated 10.08.2019.pdf www.boem.gov/BOEM-OCS-Operation-Forms/	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 553.11a(1); 40; 41

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	BOEM-1016	Designated Applicant Information Certificaton	BOEM-1016 Designated Applicant_updated 10.08.2019.pdf	http://www.boem.gov/BOEM-OCS-Operation-Forms/	Yes	Yes	Fillable Printable
Instruction			BOEM PRA 1016-1025-PRA-cover-sheet 2016 draft.docx	http://www.boem.gov/BOEM-OCS-Operation-Forms/	Yes	Yes	Printable Only

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 140

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	250	50	200
Annual IC Time Burden (Hours)	750	550	200
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.