Information Collection

Request to Modify or Terminate a CAA (43 CFR 3173.18 and 3173)

IC 228366 under ICR 202408-1004-001 · OMB 1004-0137.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1004-0137 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3160-5 Request to Modify or Terminate a CAA (43 CFR 3173.18 and 3173)	Form and Instruction
Form 3160-5 Sundry Notices and Reports on Wells Request to Modify or Terminate a CAA (43 CFR 3173.18 and 3173)	Form and Instruction
3160-005 Revised Instructions 05.29.2024 V2.docx	Instruction
3160-005 Revised Instructions 05.29.2024 V2.docx	Instruction
3160-5 Sundry Notices and Reports on Wells 3160-005-Sundry Notices and Reports on Wells.pdf	Form and Instruction
3160-5 Sundry Notices and Reports on Wells 3160-005-Sundry Notices and Reports on Wells.pdf	Form and Instruction

IC Title:

Request to Modify or Terminate a CAA (43 CFR 3173.18 and 3173)

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 3173.20 43 CFR 3173.18

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	3160-5				Yes	Yes	Fillable Printable
Instruction					Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 25

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	20,000	20,000
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].