Information Collection

250.1004(b)(5) - Request substitution

IC 232194 under ICR 202306-1014-008 · OMB 1014-0016.

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IC Title:

250.1004(b)(5) - Request substitution

Agency IC Tracking Number:

1014-0016 '21

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.1004(b)(5)

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: 1

Number of Respondents for Small Entity: 1

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

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