Blm Sundry Notice Form PDF Details

The Bureau of Land Management (BLM) requires operators on Federal or Indian land to file Form 3160-5, also called the Sundry Notices and Reports on Wells form. The United States Department of the Interior issued this version in March 2012. It covers a range of well-related activities that fall outside the scope of drilling proposals.

What Form 3160-5 Covers

Operators use this form to report modifications, reclamation work, and well abandonment procedures. Other covered actions include acidizing, fracture treatment, and conversion to injection wells. Each submission must describe the proposed or completed operation with technical details and timelines. The form applies to oil, gas, and geothermal wells regulated under 43 CFR Part 3160.

Common reasons to file Form 3160-5 include reporting a change of operator, requesting approval for well deepening, or notifying BLM about a surface restoration plan. You may also need it to report casing repairs, tubing changes, or mechanical integrity tests. Any activity that changes the status or physical condition of a permitted well typically requires this submission.

Filing Requirements

You must submit the form in triplicate to the appropriate BLM field office. Include the well API number, the exact surface location, and the lease or unit agreement number. Describe the proposed work in enough detail for BLM staff to evaluate it against applicable regulations. Supporting documents such as well schematics, plats, or previous approval letters may be required depending on the operation.

For time-sensitive operations, contact your local BLM office to ask about expedited review. Some routine actions, like minor surface disturbance repairs, may qualify for a streamlined approval process.

Legal and Privacy Provisions

The form carries legal weight. You must certify the accuracy of all submitted information under penalty of law. Federal statutes outline consequences for filing false or fraudulent statements. This includes fines and potential criminal penalties under 18 U.S.C. 1001.

The form also includes privacy and information-collection disclosures. These disclosures explain how BLM handles the personal data you provide. The Paperwork Reduction Act requires that each federal form display an OMB control number, which appears on the top right of the document. This notice balances the government's need for regulatory data with your right to privacy.

QuestionAnswer
Form NameBlm Sundry Notice Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessundry notice, blm sundry form, blm sundry form 3160 5, blm form 3160 5

How to Edit Blm Sundry Notice Form Online for Free

You can fill out or edit the BLM Form 3160-5 here using the FormsPal online PDF editor. The editor receives regular updates and new features that make working with PDF files faster than before. Follow these steps to get started:

Step 1: Click the "Get Form" button at the top of this page to open the editor.

Step 2: Once the editor loads, you will see the form ready to fill in. You can type in the blank fields, edit existing text, add graphics, attach your signature, and more.

Fill in the following sections of the form:

1. Start with the main section of BLM Form 3160-5. Enter all essential fields, including the well API number, operator name, lease number, and the type of notice you are filing. Providing complete details helps speed up the review process. Make sure the surface location coordinates match the records on your original BLM drilling permit.

form 3160 5 writing process detailed (step 1)

2. Move to the next section. Fill in the fields for the proposal to deepen, the certification statement, Signature, Approved by, Title, Date, and the space reserved for Federal or State use. The certification statement confirms that all data you provided is accurate and truthful.

Writing section 2 of form 3160 5

3. Complete the final section. Enter the Approved by field, any conditions of approval, the Office name, Title, and Date. If BLM attaches special conditions to the approval, they will appear in this part of the form.

form 3160 5 writing process clarified (stage 3)

Double-check the Office field before moving on. Many users make errors in this part of the form.

Step 3: After proofreading your entries, click "Done" to finish. With a free trial account, you can download the completed BLM Sundry Notice form or send it by email right away. The document is also saved to your account for future access. FormsPal keeps your data secure, so you do not need to worry about unauthorized access to your information.

Blm Sundry Notice Form isn’t the one you’re looking for?

Related Documents