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

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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;
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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

Absent

Known

Unknown

8) H

S Activation Plan Depth (TVD) (ft):

9) Rig Name:

10) SubSea BOP:

Yes

11) Water Depth (ft):

12) RKB Height (ft):

13) Mineral Code:

14) Drive Pipe Size (in):

15) Drive Pipe Depth (ft):

16) Anchors

Yes

17) Well Design Information

Interval Number:

Type:

Name:

Section

Casing

Burst Rating

Collapse

Depth (ft)

Pore

Number

Size (in)

Weight

Grade

(psi)

Rating (psi)

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)

Cement Volume (ft

)

Interval Number:

Type:

Name:

Section

Casing

Burst Rating

Collapse

Depth (ft)

Pore

Number

Size (in)

Weight

Grade

(psi)

Rating (psi)

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)

Cement Volume (ft

)

Interval Number:

Type:

Name:

Section

Casing

Burst Rating

Collapse

Depth (ft)

Pore

Number

Size (in)

Weight

Grade

(psi)

Rating (psi)

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)

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