CERTIFICATION:
I certify that the information submitted is complete and accurate
to the best of my knowledge. I understand that making a false
statement may subject me to the criminal penalties of 18 U.S.C.
1001.
Name
and Title: ________________________________________ Date:
________________________
PAPERWORK
REDUCTION ACT OF 1995 (PRA) STATEMENT:
The PRA (44 U.S.C. 3501 et
seq.)
requires us to inform you that we collect this information to
evaluate the results of well test. BSEE uses this information to
determine if reservoirs are being depleted in a manner that will
lead to the greatest ultimate recovery of hydrocarbons and to
ascertain that oil and gas wells continue to be capable of
producing maximum production rates if assigned. Responses are
mandatory (43 U.S.C. 1334). Proprietary data are covered under
30 CFR 250.197. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information
unless it displays a currently valid OMB Control Number. Public
reporting burden for this form is estimated to average 0.1 to 3
hours per form depending on the number of well tests reported,
including the time for reviewing instructions, gathering and
maintaining data, and completing and reviewing the form. Direct
comments regarding the burden estimate or any other aspect of
this form to the Information Collection Clearance Officer, Bureau
of Safety and Regulatory Enforcement, 381 Elden Street, Herndon,
VA 20170.
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