UNITED STATES DEPARTMENT OF THE INTERIOR 

OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT

SMALL OPERATOR ASSISTANCE APPLICATION

OMB NO. 1029-0061 

EXPIRES: 7/31/2021 

Date of Application: __________________

A. BACKGROUND

1. Permit Applicant's:

_____________________________________________________ (____)_______________________

FIRST NAME M.I. LAST NAME AREA CODE PHONE NUMBER

______________________________________________________________________________________

COMPANY NAME

______________________________________________________________________________________

UTHORIZED COMPANY OFFICIAL AND TITLE

___________________________________ __________________ ______________

 CITY STATE ZIP

______________________________________________________________________________________

AUTHORIZED COMPANY OFFICIAL AND TITLE

2. Operator's name and address, if different than applicant:

_________________________________________________________________

3. Applicant is an individual (or) a partnership (or) a 

corporation . Date of Information: __________________

4. Has applicant ever been denied Small Operator Assistance? Yes ___ No ___

If yes, attach a full explanation of the circumstances and reasons for denial.

____________________________________________________________________________

PAPERWORK REDUCTION STATEMENT

The Paperwork Reduction Act of 1995 (44 U.S.C. 3501) requires us to inform you that: Federal Agencies 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. 

This information is being collected in order to determine applicant's qualification under the Small Operator Assistance Program. The 

obligation to respond is required to obtain a benefit. Proprietary information will be held confidential.

Public reporting burden for this form is estimated to average 18 hours per response including time for reviewing instructions,

gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any 

other aspect of this form to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, 

1849 C Street, NW, Room 4559, Washington, DC 20240. 
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5. Has applicant ever had a Small Operator Assistance Project with Either OSM or a State

Regulatory Authority. Yes No . If yes, complete below:

 DATE SOAP

PROJECT NAME CONTRACTOR OSM OR STATE REPORT RECEIVED

B. PERMIT INFORMATION FOR PROPOSED ASSISTANCE SITE

1. Is site currently permitted? Yes ___ No ___

2. If permitted, give: Permit Number _________________ Issue date ___________

3. What are the anticipated starting and termination dates of the mining operation?

From ______________ To _____________

4. Name and location of proposed permit site:

a. NAME: ___________________________________________

b. COUNTY: _________________________________________

c. LATITUDE: ________________________________________

d. LONGITUDE: _______________________________________

e. NAME OF NEAREST STREAM: ___________________________

5. Method of Mining (check appropriate box):

AREA STRIPPING ( ) MOUNTAINTOP REMOVAL ( )

DEEP MINE ( ) AUGER OPERATION ( ) 

CONTOUR STRIPPING ( ) OTHER ( ) 

If other describe: ___________________________________________

6. Number of acres in permit area (nearest tenth): ____________________

7. (a) PROBABLE DEPTH OF COAL RESOURCE: 

AVERAGE DEPTH TO COAL __________ FEET

MAXIMUM DEPTH TO COAL __________ FEET

(b) PROBABLE THICKNESS OF COAL RESOURCES: 

__________FEET __________ INCHES 

(c) Are there multiple seams? Yes ___ No ___ 

If yes, attach depth and thickness information for each additional seam.

(d) Estimate of reserves in the permit area and method of calculation.
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8. State the projected production for each year of the permit area for which assistance is

being sought.

SOAP Site

YEAR (1) ___________________________________________

YEAR (2) ___________________________________________

YEAR (3) ___________________________________________

YEAR (4) ___________________________________________

YEAR (5) ___________________________________________

C. MAPS

Provide U.S. Geological Survey topographical map of 1:24,000 scale or larger, or a topographic 

map of equivalent detail which clearly shows:

(a) The boundaries of the proposed permit area and the natural drainage above and 

below the affected area.

(b) Property boundaries and the name of record for property owners within the 

permit area and on adjacent lands.

(c) The location of existing structures and developed water sources within the permit 

area and on adjacent lands.

(d) The location of existing and proposed test borings or core sampling.

(e) The location and extent of known workings of any underground mines within the 

permit area and adjacent area.

D. DOCUMENTATION

Provide copies of documents which show that:

1. The applicant has a legal right to enter and mine coal within the permit area; and

2. A legal right-of-entry has been obtained for the Office of Surface Mining Reclamation

and Enforcement and laboratory personnel to inspect the lands to be mined and

adjacent lands which may be affected to collect environmental data, or to install

monitoring equipment.
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E. ATTRIBUTED PRODUCTION

(during past 12 months)

1. (a) Are other mines owned or operated by the applicant? Yes ___ No ___

(b) Does the applicant control any other mine ("control" means, but is not limited to, 

direction of the management)? Yes ___ No ___

(c) Does the applicant own more than Ten percent (10%) interest in any other coal 

mining operation? Yes ___ No ___

(d) Does any person or corporation own more than a ten percent (10%) interest in 

the applicant, or directly or indirectly control the applicant by reason of stock

ownership, direction of the management, or in any other manner whatsoever? 

Yes ___ No ___

(e) Does the applicant have any direct or indirect business relationship between or 

among his/her family members and relatives owning coal-producing operations? 

Yes ___ No ___

2. If any of the above five questions (1.(a), (b), (c), (d), or (e)) are answered "Yes", provide

the information listed below for each coal mining operation operated during the past

twelve (12) months. If questions "(c)", "(d)" or "(e)" was answered "Yes", the total and

pro rata share of coal production must be furnished. List each mining operation

separately and attach extra sheets as needed.

(a) NAME OF COMPANY ________________________________________________

(b) MINE LOCATION (County) ______________________ STATE _______________

(c) SURFACE MINE OR UNDERGROUND MINE PERMIT NO. ________________________

(d) MESA (MSHA) I.D. NO FOR THE MINE SITE ________________________________

(e) STATE COAL SEVERANCE TAX VENDOR NO. ________________________________

(f) TONS OF COAL PRODUCED (attach legible copy of coal severance tax return for 

each month during most recent 12 months) __________. Pro rata share ______

3. State the total projected production for each year of the proposed permit for which

assistance is being sought.

Other Operation(s)

YEAR (1) __________________________________________

YEAR (2) __________________________________________

YEAR (3) __________________________________________

YEAR (4) __________________________________________

YEAR (5) __________________________________________
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F. UNDERTAKING OF APPLICANT

The undersigned, as a duly authorized representative of the applicant, hereby agrees that the 

applicant intends to apply for a permit pursuant to the regulations and shall, if the applicant 

receives small operator assistance:

1. Fully cooperate with all laboratories, their employees and agents that will produce the

determination and statement:

2. When requested, submit coal production information for the area affected by this

application and for any other mining operation in which the applicant has an interest or

an operation which has an interest in the applicant; said information is to be furnished

with thirty (30) days of the end of twelve (12) months following issuance of the permit for

which assistance is provided; and,

3. Notify the Office of Surface Mining Reclamation and Enforcement in writing with 10 days

of any change (a) in ownership or mining plans that may affect assistance eligibility or

permit eligibility pursuant to the information in this application, or (b) that may require a

change in the scope of work being performed by the contractor.

4. Refund, within 30 days to the Office of Surface Mining Reclamation and Enforcement,

the full amount for small operator assistance paid pursuant to this application (with

computed interest penalty) in accordance with 795.12(a), upon presentation of

appropriate receipts, of any of the following conditions occur:

(a) Information submitted as required by paragraph (2) above or from the abandoned 

mine lands fee compliance system shows actual and attributed coal production to 

be in excess of 300,000 tons during the 12-month period following issuance of 

the permit for which assistance is provided;

(b) Knowingly submits false information;

(c) Fails to submit a permit application within one (1) year from the date of receipt of 

the approved laboratory report;

(d) Fails to commence mining after obtaining a permit;

(e) Sells, transfers or assigns the permit to another person or company and the 

transferee's total actual and attributed production exceeds the 300,000 ton 

annual production limit during the 12-month period following permit issuance. In 

this case, the applicant and its successor shall be jointly and severally obligated 

for reimbursement.
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5. The operator, represented by the authorized company official (signature below), agrees

to assume responsibility for the care, maintenance and eventual disposal of any groundwater observation wells drilled on their behalf. Upon completion of the Small Operator

Assistant Program study, the use of and responsibility for these wells shall transfer to the

operator. Furthermore, it shall be the responsibility of the operator to meet all

appropriate State and Federal regulations regarding the continued use and/or eventual

abandonment of these wells.

G. 

Subscribed and sworn before me this _________day of ______________________, 20_____. 

My commission expires __________________________

______________________________________________

(Notary Public)

AFFIDAVIT

I, _______________________________, as the applicant, or as a duly authorized 

representative, being first duly sworn, state that to the best of my knowledge, all information 

furnished in this application is true and complete.

by _____________________________________

 signature

________________________________________

 Title

State of ______________________________________

County of _____________________________________