Information Collection

250.1202-1204 Simple Application - LHM

IC 221604 under ICR 202607-1014-003 · OMB 1014-0002.

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IC Title:

250.1202-1204 Simple Application - LHM

Agency IC Tracking Number:

1014-0002 ext 26

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.1204(a) 30 CFR 250.1202(a),(b); 1203(b)

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 Resource Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 5

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10	-29	39
Annual IC Time Burden (Hours)	90	-261	351
Annual IC Cost Burden (Dollars)	13,710	-48,495	62,205

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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