U.S. Department of the Interior
OMB Control Number 1014-0022
Bureau of Safety and Environmental Enforcement (BSEE)
OMB Approval Expires 08/31/2017
HURRICANE AND TROPICAL STORM EVACUATION
AND PRODUCTION CURTAILMENT STATISTICS
GULF OF MEXICO OCS REGION (GOMR)
SEND COMPLETED FORM VIA E-MAIL OR TELEFAX BEFORE 11:00 A.M. DAILY
DURING THE PERIOD OF EVACUATION AND SHUT-IN TO:
E-MAIL: EVACSTATS@BSEE.GOV
FAX:
GOMR (Primary) - (504) 736-5796
GOMR (Alternate) - (504) 736-2426
BSEE Headquarters (if GOMR office is closed) - (703) 787-1093
Name of Hurricane/Tropical Storm: __________________________________________________________
Company: ___________________________________ Contact: __________________________________
Telephone Number: ____________________ Date: ___________________ Time: _________________
EVACUATION STATISTICS BY GOMR DISTRICT OFFICE
Lake
Lake
New
TYPE OF FACILITY
Lafayette
Houma
TOTAL
Jackson
Charles
Orleans
No. of platforms evacuated
No. of drilling rigs evacuated
No. of platforms not
evacuated
No. of drilling rigs not
evacuated
PRODUCTION SHUT-IN STATISTICS BY GOMR DISTRICT OFFICE
Lake
Lake
New
TYPE OF PRODUCTION
Lafayette
Houma
TOTAL
Jackson
Charles
Orleans
Oil (BOPD)
Gas (MMSCFD)
Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that BSEE collects this
information to be informed when operations and production are disrupted due to hurricanes or natural disasters. BSEE uses this information to
notify the Coast Guard in case of rescue needs and oil spills; to monitor when production is shut-in and when resumed; and to notify the news
media and interested public entities. Responses are mandatory (43 U.S.C. 1331 et seq.). No proprietary information is collected. An agency may
not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a currently valid OMB Control
Number. Public reporting burden for this form is estimated to average 1 hour per response, including the time for reviewing instructions, gathering
and maintaining data, and completing and reviewing the form. You may 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.
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 the criminal penalties of 18 U.S.C. 1001.
Name and Title: ________________________________________
Date: ________________________
BSEE
Page 1 of 1
Form BSEE-0132
(Aug/2014 -- Supersedes all previous editions of this form which may not be used.)