OFFICE of SURFACE MINING
RECLAMATION and ENFORCEMENT

U.S. Department of the Interior

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For More Information:

Paul Ehret
Division of Regulatory Support
pehret@osmre.gov
(202) 208-4479


Contact OSMRE

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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
OSM-1 Coal Reclamation Fee Report 2/28/21
OSM-1 Amended Amended, Coal Reclamation Fee Report 2/28/21
OSM-1 (online) Coal Reclamation Fee Report File none given
OSM-1 Instructions Instructions for OSM-1, Coal Reclamation Fee Report 2/28/21
OSM-23 State Employee Statement of Employment and Financial Interest 08/31/20
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 04/30/20
OSM-105 Nomination and Request for Payment Form for OSM Technical Training Courses 02/28/22
OMB 1029-0061 Small Operator Assistance Application 07/31/21
OMB 1029-0119 AML Contractor Information Form 10/31/2021
OMB 1029-0119 Instructions Instructions for Completing the AML Contractor Form none given
OMB 1029-0118 Citizen's Request for an Inspection 12/31/20
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 10/31/2021
Surety Bond (Corporation) Surety Bond (Corporation) 10/31/2021
Surety Bond (Partnership) Surety Bond (Partnership) 10/31/2021
Surety Bond (Sole Proprietorship) Surety Bond (Sole Proprietorship) 10/31/2021
Assignment of Certificate of Deposit for Collateral Bond (Corporation) Assignment of Certificate of Deposit for Collateral Bond (Corporation) 10/31/2021
Assignment of Certification of Deposit for Collateral Bond (Partnership) Assignment of Certification of Deposit for Collateral Bond (Partnership) 10/31/2021
Assignment of Certification of Deposit for Collateral Bond (Sole Proprietorship) Assignment of Certification of Deposit for Collateral Bond (Sole Proprietorship) 10/31/2021
Escrow Agreement Escrow Agreement 10/31/2021
Collateral Bond and Indemnity Agreement (Corporation) Collateral Bond and Indemnity Agreement (Corporation) 10/31/2021
Amendment to Collateral Bond and Indemnity Agreement (Corporation) Amendment to Collateral Bond and Indemnity Agreement (Corporation) 10/31/2021
Collateral Bond and Indemnity Agreement (Partnership) Collateral Bond and Indemnity Agreement (Partnership) 10/31/2021
Amendment to Collateral Bond and Indemnity Agreement (Partnership) Amendment to Collateral Bond and Indemnity Agreement (Partnership) 10/31/2021
Collateral Bond and Indemnity Agreement (Sole Proprietorships) Collateral Bond and Indemnity Agreement (Sole Proprietorships) 10/31/2021
Amendment to Collateral Bond and Indemnity Agreement (Sole Proprietorships) Amendment to Collateral Bond and Indemnity Agreement (Sole Proprietorships) 10/31/2021
Application for Self-Bond Application for Self-Bond 10/31/2021
Irrevocable Letter of Credit Irrevocable Letter of Credit 10/31/2021
Mortgage or Deed of Trust Mortgage or Deed of Trust 10/31/2021
Power of Attorney and Agreement for Collateral Bond (Corporation) Power of Attorney and Agreement for Collateral Bond (Corporation) 10/31/2021
Power of Attorney and Agreement for Collateral Bond (Partnership) Power of Attorney and Agreement for Collateral Bond (Partnership) 10/31/2021
Power of Attorney and Agreement for Collateral Bond (Sole Proprietorship) Power of Attorney and Agreement for Collateral Bond (Sole Proprietorship) 10/31/2021
Self-Bond Agreement Self-Bond Agreement 10/31/2021
Self-Bond Indemnity Agreement Self-Bond Indemnity Agreement 10/31/2021
Self-Bond Corporate Guarantee Self-Bond Corporate Guarantee 10/31/2021
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) 08/31/20
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) 08/31/20
Technical Transfer Evaluation To better provide technical transfer activities in the future, we would appreciate your input by completing this form 08/31/20
Financial Assistance-Optional OSMRE Forms
OSMRE-47 Budget Information Report 07/31/21
OSMRE-47 Instructions Instructions for completing Budget Information Form none given
OSMRE-49 Budget Information and Financial Reporting 07/31/21
OSMRE-49 Instructions Instructions for completing the Budget Information and Financial Reporting form none given
OSMRE-51 Performance Report/Program Narrative Statement 07/31/21
OSMRE-60 Report of Government Property

Note: As of 8/8/13, this form has been discontinued. Please use SF-428 and SF-429
N/A
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
Financial Assistance Forms - Pre and Post Award Reporting
All forms can be found at www.grants.gov.
SF-425 OSMRE Guidance OSMRE Guidance for Federal Financial Report SF-425 none given
SF-LLL Disclosure of Lobbying Activities 07/31/15
(OPM) - Office of Personnel Management Forms
All forms can be found at www.opm.gov/forms.

Page Last Modified/Reviewed: 8/20/19

Office of Surface Mining Reclamation and Enforcement, 1849 C Street NW, Washington, DC 20240
(202) 208-2565 | TTY: (202) 208-2694 | Email: getinfo@osmre.gov


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