Designation of Designee

Collection of Monies Due the Federal Government

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1012-0008 can be found here:

Documents and Forms

Document Name Document Type
Form 4425 Designation of Designee Form and Instruction
4425 Designation Form for Royalty Payment Responsibility form ONRR-4425.pdf www.onrr.gov/Laws_R_D/FRNotices/ICR0107.htm Form and Instruction

Information Collection (IC) Details

IC Title:	Designation of Designee	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4425	Designation Form for Royalty Payment Responsibility	form ONRR-4425.pdf	https://www.onrr.gov/Laws_R_D/FRNotices/ICR0107.htm	Yes	Yes	Printable Only

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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	-4	5
Annual IC Time Burden (Hours)	1	-3	4
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.