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OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT

Forms, Applications, & Instructions

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(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
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Freedom of Information Act (FOIA) Form
N/A

Safety Form
N/A

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