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Division of Reclamation Regulatory Forms
| Title | Form Number Electronic Format |
|---|---|
| Coal Exploration | |
| Application for Approval to Conduct Coal Exploration Activities under 250 Tons | 50616.pdf |
| Coal Mining Permitting | |
| Request For Renewal Of Blaster Certification | 54002.pdf 54002.doc |
| Application For Blaster Certification | 54003.pdf 54003.doc |
| Application for an Incidental Boundary Revision to a Previously Approved Permit | 50617.pdf |
| Certificate of Liability Insurance | 50613.pdf |
| Report of Coal Production & Reclamation Fee | 44984.pdf |
| Request For Exemption For Coal Extraction Incidental to the Extraction of Other Minerals | 50614.pdf |
| Semi-Annual Seeding Report (B-601) | 50619.pdf |
| Coal Mine Bond | |
| Bond Pool Application | 51507.pdf |
| Collateral Assignment of Certificate of Deposit (CA-1) | 50625.pdf |
| Collateral Assignment of Deposit Account (DA-1) | 50624.pdf |
| Irrevocable Letter of Credit (LC-1) | 6733.pdf |
| Irrevocable Letter of Credit Amendment (LC-2) | 50622.pdf |
| Self-Bond Application | 51895.pdf |
| Self-Bond Indemnity Agreement and Absolute Corporate Guaranty | 51892.pdf |
| Self-Bond Indemnity Agreement and Absolute Corporate Guaranty Rider (SE-1) | 51894.pdf |
| Self-Bond Indemnity Agreement and Absolute Corporate Guaranty Rider with Guarantor (SE-2) | 51951.pdf |
| Surety Bond (SB-1) | 50621.pdf |
| Surety Bond Rider (SB-2) | 6732.pdf |
| Surface Coal Mine Reclamation Bond Pool Fund, New Acres (BP-1) | 51509.pdf |
| Surface Coal Mine Reclamation Bond Pool Fund (BP-2) | 51510.pdf |
| Clay and Shale Mining | |
| Clay and Shale Collateral Assignment of Certificate of Deposit | 54963.pdf |
| Clay and Shale Irrevocable Letter of Credit | 54964.pdf |
| Clay and Shale Surety Bond | 54951.pdf |
| Application for a Permit (R-100) | 2192.pdf |
| Bonding Evaluation Factor Sheet (R-102) | 20069.pdf |
| Plan of Reclamation (R-101) | 2191.pdf |
| Plan of Revegetation (R-301) | 2190.pdf |
| Report of Affected Area (R-200) | 2193.pdf |
| Report of Grading - Maps (R-300) | 20065.pdf |
| Report of Vegetation (R-302) | 20063.pdf |
| Misc Forms | |
| Citizen Complaint and State Inspection Request | 50419.pdf |