Information Collection

Technical Assistance Evaluation Form

IC 282276 under ICR 202608-1029-002 · OMB 1029-0114.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Technical Assistance Evaluation Technical Assistance Evaluation Form	Form
Technical Assistance Evaluation 1029-0114-Form.1.TechnicalAssistanceEvaluationForm.26.pdf www.osmre.gov/resources/forms	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	N/A			https://www.osmre.gov/resources/forms	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 98

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	98	98
Annual IC Time Burden (Hours)	8	8
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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