OFFICE of SURFACE MINING
RECLAMATION and ENFORCEMENT

U.S. Department of the Interior

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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-1Coal Reclamation Fee Report 12/31/14
OSMRE-1 AmendedAmended, Coal Reclamation Fee Report 12/31/14
OSMRE-1 (online) Coal Reclamation Fee Report File none given
OSMRE-1 Instructions Instructions for OSMRE-1, Coal Reclamation Fee Report none given
OSMRE-23 State Employee Statement of Employment and Financial Interest 08/31/14
OSMRE-74 Application for Blaster Certification in Federal Program States and on Indian Lands. Use to request a blaster certification in Federal Program Staes and on Indian Lands 01/31/15
OSMRE-105 Nomination and Request for Payment Form for OSM Technical Training Courses 04/30/16
OMB 1029-0061 Small Operator Assistance Application 08/31/15
OMB 1029-0119 Abandoned Mine Land Contractor 01/31/16
OMB 1029-0119 Instructions Instructions for Abandoned Mine Land Contractor none given
OMB 1029-0118 Citizen's Request for an Inspection 10/31/14
Bond Forms
General Purpose Rider for Surety Bond General Purpose Rider for Surety Bond 09/30/15
Surety Bond (Corporation) Surety Bond (Corporation) 09/30/15
Surety Bond (Partnership) Surety Bond (Partnership) 09/30/15
Surety Bond (Sole Proprietorship) Surety Bond (Sole Proprietorship) 09/30/15
Assignment of Certificate of Deposit for Collateral Bond (Corporation) Assignment of Certificate of Deposit for Collateral Bond (Corporation) 09/30/15
Assignment of Certification of Deposit for Collateral Bond (Partnership) Assignment of Certification of Deposit for Collateral Bond (Partnership) 09/30/15
Assignment of Certification of Deposit for Collateral Bond (Sole Proprietorship) Assignment of Certification of Deposit for Collateral Bond (Sole Proprietorship) 09/30/15
Escrow Agreement Escrow Agreement 09/30/15
Collateral Bond and Indemnity Agreement (Corporation) Collateral Bond and Indemnity Agreement (Corporation) 09/30/15
Amendment to Collateral Bond and Indemnity Agreement (Corporation) Amendment to Collateral Bond and Indemnity Agreement (Corporation) 09/30/15
Collateral Bond and Indemnity Agreement (Partnership) Collateral Bond and Indemnity Agreement (Partnership) 09/30/15
Amendment to Collateral Bond and Indemnity Agreement (Partnership) Amendment to Collateral Bond and Indemnity Agreement (Partnership) 09/30/15
Collateral Bond and Indemnity Agreement (Sole Propriertorships) Collateral Bond and Indemnity Agreement (Sole Propriertorships) 09/30/15
Amendment to Collateral Bond and Indemnity Agreement (Sole Propriertorships) Amendment to Collateral Bond and Indemnity Agreement (Sole Propriertorships) 09/30/15
Application for Self-Bond Application for Self-Bond 09/30/15
Irrevocable Letter of Credit Irrevocable Letter of Credit 09/30/15
Mortgage or Deed of Trust Mortgage or Deed of Trust 09/30/15
Power of Attorney and Agreement for Collateral Bond (Corporation) Power of Attorney and Agreement for Collateral Bond (Corporation) 09/30/15
Power of Attorney and Agreement for Collateral Bond (Partnership) Power of Attorney and Agreement for Collateral Bond (Partnership) 09/30/15
Power of Attorney and Agreement for Collateral Bond (Sole Propriertorship) Power of Attorney and Agreement for Collateral Bond (Sole Propriertorship) 09/30/15
Self-Bond Agreement Self-Bond Agreement 09/30/15
Self-Bond Indemnity Agreement Self-Bond Indemnity Agreement 09/30/15
Self-Bond Corporate Guarantee Self-Bond Corporate Guarantee 09/30/15
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 07/31/15
OSMRE-47 Instructions Instructions for completing Budget Information Form none given
OSMRE-49 Budget Information and Financial Reporting 07/31/15
OSMRE-49 Instructions Instructions for completing the Budget Information and Financial Reporting form none given
OSMRE-51 Performance Report/Program Narrative Statement 07/31/15
OSMRE-60 Report of Government Property

Note: As of 8/8/13, this form has been discountinued. 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
SF-424 An application for Federal assistance 08/31/16
SF-424 Instructions Instructions for completing the Federal Assistance Form none given
SF-424B Assurances for Non-Construction Programs Form 06/30/14
SF-424D Assurances for Construction Programs 06/30/14
SF-425 Federal Financial Report 02/28/15
SF-425 Instructions Federal Financial Report Instructions none given
SF-425A Federal Financial Report Attachment none given
SF-425A Instructions Federal Financial Report Attachment Instructions none given
SF-LLLDisclosure of Lobbying Activities07/31/15
(OPM) - Office of Personnel Management Forms

Page Last Modified/Reviewed: 6/30/14

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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