29; 40-41; 43 - Form BOEM-1019 - Insurance Certificate

30 CFR 553, Oil Spill Financial Responsibility for Offshore Facilities

Documents and Forms

Document Name Document Type
Form BOEM-1019 29; 40-41; 43 - Form BOEM-1019 - Insurance Certificate Form
BOEM-1019 Insurance Certificate BOEM-1019 Insurance Certificate_Updated 10.08.2019.pdf www.boem.gov/BOEM-OCS-Operation-Forms/ Form

Information Collection (IC) Details

IC Title:	29; 40-41; 43 - Form BOEM-1019 - Insurance Certificate	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 553.29; 40-41; 43

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BOEM-1019	Insurance Certificate	BOEM-1019 Insurance Certificate_Updated 10.08.2019.pdf	http://www.boem.gov/BOEM-OCS-Operation-Forms/	Yes	Yes	Fillable Printable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 84

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

Percentage of Respondents Reporting Electronically: 90 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	150	30	120
Annual IC Time Burden (Hours)	18,000	3,600	14,400
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.