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OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT

Forms, Applications, & 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.

 

  

(DI) -Department of Interior Forms
(OPM) -Office of Personnel Management Forms
(GS) -General Services Administration
(OSM) - Office of Surface Mining Forms Library
 TitleTypeDescriptionExpiration Date
1 OSM-1 .pdf Coal Reclamation Fee Report12/31/2014
1 OSM-1 Amended .pdf Amended, Coal Reclamation Fee Report12/31/2014
1 OSM-1 (online) Coal Reclamation Fee Report File12/31/2014
1 OSM-1 Instructions .pdf Instructions for OSM-1, Coal Reclamation Fee Report12/31/2014
1 OSM-23 .pdf State Employee Statement of Employment and Financial Interest8/31/2014
1 OSM-74 .pdf Application for Blaster Certification in Federal Program States and on Indian Lands. Use to request a blaster certification in Federal Program States and on Indian Lands1/31/2015
1 OMB 1029-0061 .pdf Small Operator Assistance Application8/31/2012
1 OMB 1029-0119 .pdf Abandoned Mine Land Contractor1/31/2013
1 OMB 1029-0119 Instructions .pdf Instructions for Abandoned Mine Land Contractor1/31/2013
1 Hard Copy Material .pdf Hard copy materials are available at your request free of charge while supplies last. Materials such as Annual Reports, Posters, Workbooks, etc.1/1/1900
1 OMB 1029-0118 .pdf Citizen's Request for an Inspection10/31/2014

Bond Forms
 TitleTypeDescriptionExpiration Date
2 General Purpose Rider for Surety Bond .pdf General Purpose Rider for Surety Bond9/30/2015
2 Surety Bond (Corporation) .pdf Surety Bond (Corporation)9/30/2015
2 Surety Bond (Partnership) .pdf Surety Bond (Partnership)9/30/2015
2 Surety Bond (Sole Proprietorship) .pdf Surety Bond (Sole Proprietorship)9/30/2015
2 Assignment of Certificate of Deposit for Collateral Bond (Corporation) .pdf Assignment of Certificate of Deposit for Collateral Bond (Corporation)9/30/2015
2 Assignment of Certification of Deposit for Collateral Bond (Partnership) .pdf Assignment of Certification of Deposit for Collateral Bond (Partnership)9/30/2015
2 Assignment of Certification of Deposit for Collateral Bond (Sole Proprietorship) .pdf Assignment of Certification of Deposit for Collateral Bond (Sole Proprietorship)9/30/2015
2 Escrow Agreement .pdf Escrow Agreement9/30/2015
2 Collateral Bond and Indemnity Agreement (Corporation) .pdf Collateral Bond and Indemnity Agreement (Corporation)9/30/2015
2 Amendment to Collateral Bond and Indemnity Agreement (Corporation) .pdf Amendment to Collateral Bond and Indemnity Agreement (Corporation)9/30/2015
2 Collateral Bond and Indemnity Agreement (Partnership) .pdf Collateral Bond and Indemnity Agreement (Partnership)9/30/2015
2 Amendment to Collateral Bond and Indemnity Agreement (Partnership) .pdf Amendment to Collateral Bond and Indemnity Agreement (Partnership)9/30/2015
2 Collateral Bond and Indemnity Agreement (Sole Propriertorships) .pdf Collateral Bond and Indemnity Agreement (Sole Propriertorships)9/30/2015
2 Amendment to Collateral Bond and Indemnity Agreement (Sole Propriertorships) .pdf Amendment to Collateral Bond and Indemnity Agreement (Sole Propriertorships)9/30/2015
2 Application for Self-Bond .pdf Application for Self-Bond9/30/2015
2 Irrevocable Letter of Credit .pdf Irrevocable Letter of Credit9/30/2015
2 Mortgage or Deed of Trust .pdf Mortgage or Deed of Trust9/30/2015
2 Power of Attorney and Agreement for Collateral Bond (Corporation) .pdf Power of Attorney and Agreement for Collateral Bond (Corporation)9/30/2015
2 Power of Attorney and Agreement for Collateral Bond (Partnership) .pdf Power of Attorney and Agreement for Collateral Bond (Partnership)9/30/2015
2 Power of Attorney and Agreement for Collateral Bond (Sole Propriertorship) .pdf Power of Attorney and Agreement for Collateral Bond (Sole Propriertorship)9/30/2015
2 Self-Bond Agreement .pdf Self-Bond Agreement9/30/2015
2 Self-Bond Indemnity Agreement .pdf Self-Bond Indemnity Agreement9/30/2015
2 Self-Bond Corporate Guarantee .pdf Self-Bond Corporate Guarantee9/30/2015

Directives Templates
 TitleTypeDescriptionExpiration Date
3 OPM-1 Format Template .doc Use this sample template to create a Directive1/1/1900
3 Comment Template .doc Use this sample comment form when preparing a Directive1/1/1900
3 Change Notice .doc Use this sample change notice form when making changes to an existing Directive1/1/1900
3 Rescission Change Notice .doc Use this sample rescission change notice template to rescend a Directive1/1/1900

Freedom of Information Act (FOIA) Form
Safety Form
 TitleTypeDescriptionExpiration Date
5 Safety Orientation Checklist .pdf Checklist for: Administrative Officers, Collateral Duty Safety Officers and Personnel1/1/1900

Technology Transfer Forms
 TitleTypeDescriptionExpiration Date
6 Technical Assistance Evaluation .pdf 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).5/31/2014
6 Meeting/Forum Evaluation .pdf Your response to this survey will assist us in evaluating and improving the OSM meeting/forum in which you participated (electronic version)5/31/2014
6 Technical Transfer Evaluation .pdf To better provide technical transfer activities in the future, we would appreciate your input by completing this form.5/31/2014

Financial Assistance-Standard Forms
 TitleTypeDescriptionExpiration Date
7 SF-424 .pdf An application for federal assistance3/31/2012
7 SF-424 Instructions .pdf Instructions for completing the Federal Assistance Form3/31/2012
7 SF-424B .pdf Assurances for Non-Construction Programs Form7/30/2010
7 SF-424B Instructions .pdf Instructions for completing the Assurances for Non-Construction Programs Form7/30/2010
7 SF-424D .pdf Assurances for Construction Programs7/30/2010
7 SF-424D Instructions .pdf Instructions for completing the Assurances for Construction Programs Form7/30/2010
7 SF-425 .pdf Federal Financial Report10/31/2011
7 SF-425A .pdf Federal Financial Report Attachment10/31/2011
7 SF-LLL .pdf Disclosure of Lobbying Activities7/31/2010
7 Certifications .pdf Debarment, Suspension, and Other Responsibility Matters1/1/1900

Financial Assistance-Optional OSM Forms
 TitleTypeDescriptionExpiration Date
8 OSM-47 .pdf Budget Information Report7/31/2015
8 OSM-47 Instructions .pdf Instructions for completing Budget Information Form7/31/2015
8 OSM-49 .pdf Budget Information and Financial Reporting7/31/2015
8 OSM-49 Instructions .pdf Instructions for completing the Budget Information and Financial Reporting form7/31/2015
8 OSM-51 .pdf Performance Report/Program Narrative Statement7/31/2015
8 OSM-60 .pdf Report of Government Property5/31/2012

Financial Assistance-Internal Optional OSM Forms