Information Collection

Notification of Change of Operator and Assumption of Past Liability (43 CFR 3809.116)

IC 45379 under ICR 202301-1004-002 · OMB 1004-0194.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3809-005 Notification of Change of Operator and Assumption of Past Liability (43 CFR 3809.116)	Form
Form 3809-005 Notification of Change of Operator and Assumption of Past Liability Notification of Change of Operator and Assumption of Past Liability (43 CFR 3809.116)	Form
3809-005 Notification of Change of Operator and Assumption of Pas 3809-005-Notification of Change of Operator and Assumption of Past Liability.pdf www.blm.gov/services/electronic-forms	Form
3809-005 Notification of Change of Operator and Assumption of Pas 3809-005-Notification of Change of Operator and Assumption of Past Liability.pdf www.blm.gov/services/electronic-forms	Form

IC Title:

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 3809.116

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	3809-005			https://www.blm.gov/services/electronic-forms	Yes	Yes	Fillable Printable

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

Number of Respondents for Small Entity: 42

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	57	5	52
Annual IC Time Burden (Hours)	456	40	416
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.

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