ONRR-4425 Designation Form for Royalty Payment Responsibility

OMB Control Number 1012-0008 OMB
Approval Expires - 07/31/2024

U.S. Department of the Interior
Office of Natural Resources Revenue

Designation Form for Royalty Payment Responsibility
Form ONRR-4425
SUBMIT ONE FORM PER DESIGNATION - INSTRUCTIONS ON REVERSE SIDE
(1) ONRR LEASE NUMBER
(2) BSEE/BLM AGENCY
ASSIGNED LEASE NUMBER
NOTE: IF THE PRODUCT CODE AND RESPONSIBILITY TYPE ARE NOT COMPLETED, ONRR WILL ASSUME THE DESIGNATION COVERS ALL
(3) PRODUCT CODE
(4) RESPONSIBILITY TYPE

RENT

(5) EFFECTIVE DATE (MMDDYY)

MINIMUM ROYALTY

ROYALTY

(6) TERMINATION DATE (MMDDYY)

PLEASE PROVIDE THE FOLLOWING INFORMATION AS LESSEE:
(7) PAYOR CODE

(8) TAX IDENTIFICATION NUMBER

(9) LESSEE NAME:
LESSEE ADDRESS:

CITY, STATE, ZIP:
LESSEE EMAIL ADDRESS:
FAX:

TELEPHONE:

PLEASE PROVIDE THE FOLLOWING INFORMATION REGARDING DESIGNEE:
(10) PAYOR CODE

(11) TAX IDENTIFICATION NUMBER

(12) DESIGNEE NAME:
DESIGNEE ADDRESS:

CITY, STATE, ZIP:
DESIGNEE EMAIL ADDRESS:
TELEPHONE:

FAX:

PLEASE SIGN THE SIGNATURE LINE BELOW:
Check Box
(14) SIGNATURE

(13) LESSEE OF RECORD

(13) OPERATING RIGHTS OWNER

(Lessee of Record or Operating Rights Owner)

Form ONRR-4425 (revised 07/31/2021)

DATE

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INSTRUCTIONS
for Form ONRR-4425
Mandatory items are in bold print.
1.

ONRR Lease Number - is a 10-digit number that ONRR converts from the BLM or BOEMRE assigned lease number, i.e.,
BLM lease number NM-12345 converts to ONRR lease number 030-12345-0.

2.

BSEE/BLM Agency Assigned Lease Number - an alpha-numeric number assigned to any contract or agreement
issued or approved by the U.S. under a mineral leasing law that authorizes exploration for, extraction of, or removal
of oil and gas.

3.

Product Code - is a 2-digit code assigned to a product description as follows:
(01) Oil

(02) Condensate

(03) Processed Gas

(04) Unprocessed Gas (07) Gas Plant Products

(25) Geothermal

(99) Other

4.

Responsibility Type - check box if you are authorizing payment for rent, minimum royalty, royalty or all of the
above.

5.

Effective Date - The effective date of the designation.

6.

Termination Date - The termination date of the designation.

Information under lessee block:
7.

Payor Code - a 5-digit code assigned to the lessee who assumes an obligation to report and remit rental or royalty
due on the lease.

8.

Tax Identification Number - a 9-digit number that is your social security number (SSN) or employer identification
number (EIN).

9.

Lessee Name, Address, Telephone, and if available, Email address and Fax Number - please print or type.

Information under designee block:
10. Payor Code - a 5-digit code assigned to the designee who assumes an obligation to report and remit rental or royalty
due on the lease.
11. Tax Identification Number - a 9-digit number that is your social security number (SSN) or employer identification
number (EIN).
12. Name, Address, Telephone Number, and if available, Email Address and Fax Number - please print or type.
13. Check the box(es) if you are lessee or record and/or operating rights owner on this lease.
14. Signature - as lessee of record or operating rights owner, and date of signing.
Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires ONRR to inform you that we collect this
information to identify who is responsible for making royalty and related payments on Federal leases. The Federal Oil and Gas Royalty
Simplification and Fairness Act of 1996 (Public Law 104-185) clearly establishes the owners of operating rights and/or lease record title as
responsible for making royalty and related payments on a Federal lease. The ONRR uses the information that payors provide, regarding the
lessees on whose behalf that they are paying, to determine if we need to inform those lessees that they must certify to ONRR in writing their
respective payors as their designees. Responses are mandatory (43 U.S.C. 1334). Proprietary information is protected in accordance with
standards established by the Federal Oil and Gas Royalty Management Act of 1982 (30 U.S.C. 1733), the Freedom of Information Act [5
U.S.C. 552(b)(4)], and the Department regulations (43 CFR 2). An agency may not conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden for this form is estimated to
average 0.75 hour per response, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the
form. Direct comments regarding the burden estimate or any other aspect of this form to ONRR Rules & Regs Team, PO Box 25165, MS
64000A, Denver, CO 80225.
Privacy Act Statement: This system contains information protected under the provisions of the Privacy Act of 1974 (Public Law 93-579).
Authority: This information is being solicited under the authority of The Federal Oil and Gas Royalty Management Act of 1982, 30 U.S.C.
1701-1759; Chapter 12 of Title 25 of the U.S. Code, addressing the lease, sale, or surrender of allotted or unallotted lands, found at 25 U.S.C.
391-416j; Chapter 3A of Title 30 of the U.S. Code, addressing leases and prospecting permits, found at 30 U.S.C. 181-196; and the Outer
Continental Shelf Lands Act, 43 U.S.C. 1331-1356b.
Purpose: The primary purpose for collecting this information is to collect royalties and rents; control revenues; distribute funds collected;
maintain records of royalty accounts and associated sales, and production information.
Routine Uses: The routine use of this data is to facilitate comparative auditing of mineral production, royalties due, revenues collected, and
funds distributed; gather statistics for managing the mineral leasing program; provide informational access to external users including states,
Indian tribes or agencies, and Federal agencies; and provide outreach services to the Indian community.
Citation: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, all or a portion of the records or
information contained in this system may be disclosed outside DOI as a routine use pursuant to 5 U.S.C. 552a(b)(3) as found in the published
system of records notice, Minerals Revenue Management Support System (MRMSS), OS-30 (Replaces MMS-1) - March 25, 2016, 81 FR
16207, which may be viewed at: https://www.govinfo.gov/content/pkg/FR-2016-03-25/html/2016-06813.htm.
Furnishing the information on the form is voluntary; however, failure to provide the mandatory information required by the form and 30 C.F.R. §
1210.52(a)(1-10), will prevent a lessee from designating a person to make royalty payments on its behalf. See 30 U.S.C. § 1712(a); see also 30
C.F.R. §1210.158.
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Form ONRR-4425 (revised 05/08/2023)