Form BSEE-0123S "Supplemental Apd Information Sheet (Casing Design)"

What Is Form BSEE-0123S?

This is a legal form that was released by the U.S. Department of the Interior - Bureau of Safety and Environmental Enforcement on June 1, 2020 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2020;
  • The latest available edition released by the U.S. Department of the Interior - Bureau of Safety and Environmental Enforcement;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form BSEE-0123S by clicking the link below or browse more documents and templates provided by the U.S. Department of the Interior - Bureau of Safety and Environmental Enforcement.

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Download Form BSEE-0123S "Supplemental Apd Information Sheet (Casing Design)"

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U.S. Department of the Interior
OMB Control No. 1014-0025
Bureau of Safety and Environmental
OMB Approval Expires 06-30-2023
Enforcement (BSEE)
Supplemental APD Information Sheet (Casing Design)
1) Operator Name:
2) Well Name (Proposed):
ST:
BP:
3) Bottom Hole Lease:
4) Surface Lease:
5) API Number:
6)Type of Well:
Exploratory
Development
7) H
S:
Absent
Known
Unknown
8) H
S Activation Plan Depth (TVD) (ft):
2
2
9) Rig Name:
10) SubSea BOP:
Yes
No
11) Water Depth (ft):
12) RKB Height (ft):
13) Mineral Code:
14) Drive Pipe Size (in):
15) Drive Pipe Depth (ft):
16) Anchors
Yes
No
17) Well Design Information
Interval Number:
Type:
Name:
Section
Casing
Casing
Casing
Burst Rating
Collapse
Depth (ft)
Pore
Number
Size (in)
Weight
Grade
(psi)
Rating (psi)
MD
Pressure
(#/ft)
TVD
(ppg)
GENERAL INFORMATION
PREVENTER INFORMATION
TEST INFORMATION
Hole Size (in)
Type
Annular Test (psi)
Mud Weight (ppg)
Size (in)
BOP/Diverter Test (psi)
Mud Type Code
Wellhead Rating (psi)
Mud Test Weight (ppg)
Frac Gradient (ppg)
Annular Rating (psi)
Casing/Liner Test (psi)
Liner Top Depth (ft)
BOP/Diverter Rating (psi)
Formation Test (ppg)
3
Cement Volume (ft
)
Interval Number:
Type:
Name:
Section
Casing
Casing
Casing
Burst Rating
Collapse
Depth (ft)
Pore
Number
Size (in)
Weight
Grade
(psi)
Rating (psi)
MD
Pressure
(#/ft)
TVD
(ppg)
GENERAL INFORMATION
PREVENTER INFORMATION
TEST INFORMATION
Hole Size (in)
Type
Annular Test (psi)
Mud Weight (ppg)
Size (in)
BOP/Diverter Test (psi)
Mud Type Code
Wellhead Rating (psi)
Mud Test Weight (ppg)
Frac Gradient (ppg)
Annular Rating (psi)
Casing/Liner Test (psi)
Liner Top Depth (ft)
BOP/Diverter Rating (psi)
Formation Test (ppg)
3
Cement Volume (ft
)
Interval Number:
Type:
Name:
Section
Casing
Casing
Casing
Burst Rating
Collapse
Depth (ft)
Pore
Number
Size (in)
Weight
Grade
(psi)
Rating (psi)
MD
Pressure
(#/ft)
TVD
(ppg)
GENERAL INFORMATION
PREVENTER INFORMATION
TEST INFORMATION
Hole Size (in)
Type
Annular Test (psi)
Mud Weight (ppg)
Size (in)
BOP/Diverter Test (psi)
Mud Type Code
Wellhead Rating (psi)
Mud Test Weight (ppg)
Frac Gradient (ppg)
Annular Rating (psi)
Casing/Liner Test (psi)
Liner Top Depth (ft)
BOP/Diverter Rating (psi)
Formation Test (ppg)
3
Cement Volume (ft
)
* NOTE*
For additional casing/liner intervals, please submit an additional Form BSEE-0123S.
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 criminal penalties under 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 obtain knowledge of equipment and procedures to be used in drilling operations. BSEE uses the
information to evaluate and approve or disapprove the adequacy of the equipment and/or procedures to safely perform the proposed
drilling operation. 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. The burden to fill out Forms BSEE-0123 + BSEE-0123S is estimated at 1 hour per response. Direct comments
regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Bureau of Safety and
Environmental Enforcement, 45600 Woodland Road, Sterling, VA 20166.
BSEE
Form BSEE-0123S
(June 2020-Supersedes all previous versions of this form which may not be used.) Page 1 of 1
U.S. Department of the Interior
OMB Control No. 1014-0025
Bureau of Safety and Environmental
OMB Approval Expires 06-30-2023
Enforcement (BSEE)
Supplemental APD Information Sheet (Casing Design)
1) Operator Name:
2) Well Name (Proposed):
ST:
BP:
3) Bottom Hole Lease:
4) Surface Lease:
5) API Number:
6)Type of Well:
Exploratory
Development
7) H
S:
Absent
Known
Unknown
8) H
S Activation Plan Depth (TVD) (ft):
2
2
9) Rig Name:
10) SubSea BOP:
Yes
No
11) Water Depth (ft):
12) RKB Height (ft):
13) Mineral Code:
14) Drive Pipe Size (in):
15) Drive Pipe Depth (ft):
16) Anchors
Yes
No
17) Well Design Information
Interval Number:
Type:
Name:
Section
Casing
Casing
Casing
Burst Rating
Collapse
Depth (ft)
Pore
Number
Size (in)
Weight
Grade
(psi)
Rating (psi)
MD
Pressure
(#/ft)
TVD
(ppg)
GENERAL INFORMATION
PREVENTER INFORMATION
TEST INFORMATION
Hole Size (in)
Type
Annular Test (psi)
Mud Weight (ppg)
Size (in)
BOP/Diverter Test (psi)
Mud Type Code
Wellhead Rating (psi)
Mud Test Weight (ppg)
Frac Gradient (ppg)
Annular Rating (psi)
Casing/Liner Test (psi)
Liner Top Depth (ft)
BOP/Diverter Rating (psi)
Formation Test (ppg)
3
Cement Volume (ft
)
Interval Number:
Type:
Name:
Section
Casing
Casing
Casing
Burst Rating
Collapse
Depth (ft)
Pore
Number
Size (in)
Weight
Grade
(psi)
Rating (psi)
MD
Pressure
(#/ft)
TVD
(ppg)
GENERAL INFORMATION
PREVENTER INFORMATION
TEST INFORMATION
Hole Size (in)
Type
Annular Test (psi)
Mud Weight (ppg)
Size (in)
BOP/Diverter Test (psi)
Mud Type Code
Wellhead Rating (psi)
Mud Test Weight (ppg)
Frac Gradient (ppg)
Annular Rating (psi)
Casing/Liner Test (psi)
Liner Top Depth (ft)
BOP/Diverter Rating (psi)
Formation Test (ppg)
3
Cement Volume (ft
)
Interval Number:
Type:
Name:
Section
Casing
Casing
Casing
Burst Rating
Collapse
Depth (ft)
Pore
Number
Size (in)
Weight
Grade
(psi)
Rating (psi)
MD
Pressure
(#/ft)
TVD
(ppg)
GENERAL INFORMATION
PREVENTER INFORMATION
TEST INFORMATION
Hole Size (in)
Type
Annular Test (psi)
Mud Weight (ppg)
Size (in)
BOP/Diverter Test (psi)
Mud Type Code
Wellhead Rating (psi)
Mud Test Weight (ppg)
Frac Gradient (ppg)
Annular Rating (psi)
Casing/Liner Test (psi)
Liner Top Depth (ft)
BOP/Diverter Rating (psi)
Formation Test (ppg)
3
Cement Volume (ft
)
* NOTE*
For additional casing/liner intervals, please submit an additional Form BSEE-0123S.
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 criminal penalties under 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 obtain knowledge of equipment and procedures to be used in drilling operations. BSEE uses the
information to evaluate and approve or disapprove the adequacy of the equipment and/or procedures to safely perform the proposed
drilling operation. 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. The burden to fill out Forms BSEE-0123 + BSEE-0123S is estimated at 1 hour per response. Direct comments
regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Bureau of Safety and
Environmental Enforcement, 45600 Woodland Road, Sterling, VA 20166.
BSEE
Form BSEE-0123S
(June 2020-Supersedes all previous versions of this form which may not be used.) Page 1 of 1