Information Collection

Designation of Designee

IC 10806 under ICR 202402-1012-001 · OMB 1012-0008.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ONRR-4425 Designation of Designee	Form and Instruction
Form ONRR-4425 Designation Form for Payment Responsibility Designation of Designee	Form and Instruction
ONRR-4425 Designation Form for Payment Responsibility 4425_03.12.2024cc.docx www.onrr.gov/document/4425.pdf	Form and Instruction
ONRR-4425 Designation Form for Payment Responsibility 4425_03.12.2024cc.docx www.onrr.gov/document/4425.pdf	Form and Instruction

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: 30 CFR 1218.52(a), (c), and (d)

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 and Instruction	ONRR-4425			https://www.onrr.gov/document/4425.pdf	Yes	Yes	Fillable Fileable

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: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	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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