Information Collection

250.1743(a) - Signed Certification

IC 225532 under ICR 202208-1014-006 · OMB 1014-0026.

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IC Title:

250.1743(a) - Signed Certification

Agency IC Tracking Number:

1014-0026 APM '23

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.1743(a)

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

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 4

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

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