OFFICE of SURFACE MINING
RECLAMATION and ENFORCEMENT

U.S. Department of the Interior

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For More Information:

John Trelease
Division of Regulatory Support
Washington, DC
jtrelease@osmre.gov
(202) 208-2783


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Forms, Applications, and Instructions

This site provides the most current official version of forms, applications, and instructions. We are linking you directly to the websites of the originators of the forms. This site links to the following form libraries: Department of the Interior; Office of Personnel Management; General Services Administration, and other forms.


TITLE DESCRIPTION EXPIRATION
DATE
(DOI) - Department of Interior Forms
FOIA Request Form Freedom of Information Act (FOIA) Request Form none given
(OSMRE) - Office of Surface Mining Forms
OSMRE-1 Coal Reclamation Fee Report 12/31/17
OSMRE-1 Amended Amended, Coal Reclamation Fee Report 12/31/17
OSMRE-1 (online) Coal Reclamation Fee Report File none given
OSMRE-1 Instructions Instructions for OSMRE-1, Coal Reclamation Fee Report 12/31/17
OSMRE-23 State Employee Statement of Employment and Financial Interest 07/31/17
OSMRE-74 Application for Blaster Certification in Federal Program States and on Indian Lands. Used to request a blaster certification in Federal Program States and on Indian Lands 01/31/18
OSMRE-105 Nomination and Request for Payment Form for OSM Technical Training Courses 07/31/19
OMB 1029-0061 Small Operator Assistance Application 07/31/18
OMB 1029-0118 Citizen's Request for an Inspection 10/31/17
OMB 1029-0025 Citizen Request for Evaluation of a State Regulatory Program 12/31/18
Bond Forms
General Purpose Rider for Surety Bond General Purpose Rider for Surety Bond 11/30/18
Surety Bond (Corporation) Surety Bond (Corporation) 11/30/18
Surety Bond (Partnership) Surety Bond (Partnership) 11/30/18
Surety Bond (Sole Proprietorship) Surety Bond (Sole Proprietorship) 11/30/18
Assignment of Certificate of Deposit for Collateral Bond (Corporation) Assignment of Certificate of Deposit for Collateral Bond (Corporation) 11/30/18
Assignment of Certification of Deposit for Collateral Bond (Partnership) Assignment of Certification of Deposit for Collateral Bond (Partnership) 11/30/18
Assignment of Certification of Deposit for Collateral Bond (Sole Proprietorship) Assignment of Certification of Deposit for Collateral Bond (Sole Proprietorship) 11/30/18
Escrow Agreement Escrow Agreement 11/30/18
Collateral Bond and Indemnity Agreement (Corporation) Collateral Bond and Indemnity Agreement (Corporation) 11/30/18
Amendment to Collateral Bond and Indemnity Agreement (Corporation) Amendment to Collateral Bond and Indemnity Agreement (Corporation) 11/30/18
Collateral Bond and Indemnity Agreement (Partnership) Collateral Bond and Indemnity Agreement (Partnership) 11/30/18
Amendment to Collateral Bond and Indemnity Agreement (Partnership) Amendment to Collateral Bond and Indemnity Agreement (Partnership) 11/30/18
Collateral Bond and Indemnity Agreement (Sole Proprietorships) Collateral Bond and Indemnity Agreement (Sole Proprietorships) 11/30/18
Amendment to Collateral Bond and Indemnity Agreement (Sole Proprietorships) Amendment to Collateral Bond and Indemnity Agreement (Sole Proprietorships) 11/30/18
Application for Self-Bond Application for Self-Bond 11/30/18
Irrevocable Letter of Credit Irrevocable Letter of Credit 11/30/18
Mortgage or Deed of Trust Mortgage or Deed of Trust 11/30/18
Power of Attorney and Agreement for Collateral Bond (Corporation) Power of Attorney and Agreement for Collateral Bond (Corporation) 11/30/18
Power of Attorney and Agreement for Collateral Bond (Partnership) Power of Attorney and Agreement for Collateral Bond (Partnership) 11/30/18
Power of Attorney and Agreement for Collateral Bond (Sole Proprietorship) Power of Attorney and Agreement for Collateral Bond (Sole Proprietorship) 11/30/18
Self-Bond Agreement Self-Bond Agreement 11/30/18
Self-Bond Indemnity Agreement Self-Bond Indemnity Agreement 11/30/18
Self-Bond Corporate Guarantee Self-Bond Corporate Guarantee 11/30/18
Technology Transfer Forms
Technical Assistance Evaluation Your response to this survey will assist us in evaluating and improving our performance on the technical assistance provided for a project or activity (electronic version) 06/30/17
Meeting/Forum Evaluation Your response to this survey will assist us in evaluating and improving the OSMRE meeting/forum in which you participated (electronic version) 06/30/17
Technical Transfer Evaluation To better provide technical transfer activities in the future, we would appreciate your input by completing this form 06/30/17
Financial Assistance-Optional OSMRE Forms
OSMRE-47 Budget Information Report 06/30/18
OSMRE-47 Instructions Instructions for completing Budget Information Form none given
OSMRE-49 Budget Information and Financial Reporting 06/30/18
OSMRE-49 Instructions Instructions for completing the Budget Information and Financial Reporting form none given
OSMRE-51 Performance Report/Program Narrative Statement 06/30/18
OSMRE-60 Report of Government Property

Note: As of 8/8/13, this form has been discontinued. Please use SF-428 and SF-429 available at http://www.whitehouse.gov/omb/grants_forms/
N/A
DI-2010 Certifications Debarment, Suspension, and Other Responsibility Matters none given
Financial Assistance-Internal Optional OSMRE Forms
Application Checklist Financial Assistance Application Checklist none given
Grant and Cooperative Agreement Closeout Checklist Grant and Cooperative Agreement Closeout Checklist none given
Grant or Cooperative Agreement Monitoring Statement Grant or Cooperative Agreement Monitoring Statement none given
(GSA) General Services Administration Forms for Financial Assistance- Linked to GSA
All SF-424s Application for Federal assistance - Several forms various
SF-425 Federal Financial Report 02/28/15
SF-425 Instructions Federal Financial Report Instructions none given
SF-425 OSMRE Guidance OSMRE Guidance for Federal Financial Report SF-425 none given
SF-425A Federal Financial Report Attachment none given
SF-425A Instructions Federal Financial Report Attachment Instructions none given
SF-LLL Disclosure of Lobbying Activities 07/31/15
(OPM) - Office of Personnel Management Forms

Page Last Modified/Reviewed: 10/18/16

Office of Surface Mining Reclamation and Enforcement, 1951 Constitution Avenue NW, Washington, DC 20240
(202) 208-2565 | TTY: (202) 208-2694 | Email: osm-getinfo@osmre.gov


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