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Bureau of Mining Programs
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Forms

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Reclaim PA
Form No. Title File Format
MR0020 Good Samaritan Application
(Good Samaritan Application)
Licensing and Contract Operator Approval
Form No. Title File Format
MR0025 Application Form - Mining License, Contract Operator Approval and Ownership and Control Registration
(Application for License)

Permitting (Coal and Industrial Minerals)
Form No. Title File Format
MR0324 Application and Instructions for Bituminous Underground Mines, Prep Plants and Refuse Disposal
(Underground Permit)
MR0026 Surface Mining Near Underground Mines - MSHA Coordination Form
(MSHA Coordination Form)
MR0311 Application and Instructions for Completing Bituminous Surface Mine Permit
(Bituminous Surface Permit)
MR0010 Landowner Consent Coal "Supplemental C"
(Contractual Consent of Landowner)
MR0054 General Permit for the Construction, Operation and Maintenance of a Temporary Road Across a Watercourse
(Temporary Road Across)
MR0058 Application for Transfer of a Permit (Coal and Industrial Minerals)
(Application for Transfer of a Permit)
MR0059 General Permit for the Construction, Operation and Maintenance of an Access Road Across a Watercourse
(Operation Maintenance of Access Road)
MR0092 Coal Exploration Notice of Intent to Explore or Request for Permit Waiver.
(Coal Exploration Notice)
MR0094 Mine Employment and Production Report
(Mine Employment and Production Report)
MR0113 Cover Sheet for Reporting and Certifying Water Monitoring Data
(Water Monitoring Report Cover Sheet)
MR0307 Application for Government Financed Construction Contract (GFCC)
(GFCC Application)
MR0312 Application for Authorization to Conduct Surface Coal Mining Activities
(Surface Coal Mining Authorization Application)
MR0343 Anthracite Surface Mine Permit Application
(Anthracite Surfact Permit)
MR0372 Completion Report for Large Noncoal Mine
(Large Noncoal Completion Report)
MR0385 Coal Mining Activity Permit Renewal Application
(Activity Renewal Report)

Blasting
Form No. Title File Format
MR0027 Application for Examination and Licensed Blaster
(This Word file can be completed on-screen and saved to your PC for added convenience)

MR0021 Instructions and Application for Blasting Activity Permit
(Instructions and Application for Blasting Activity Permit)
MR0031 Instructions and Application for Explosives Storage License
(Instructions and Application for Explosives Storage License)
MR0340 Pennsylvania Standardized Blast Report
(Blast Report)
MR0439 Request for Security Access/Portal Account Blasting Activity Permit/ Blasting Activity Permit by Rule
(BAP/BAPR Portal Account)
MR0042 Explosive Purchase Permit, Explosive Sales Permit, & Underground Mining Operations Permit Application
(Explosives Sales and Purchase)

Bonding
Form No. Title File Format
MR0049 Planting and Soil Test Report for Coal
(Coal Planting and Soil Test Report)
MR0073 Appeal Bond Surety Guarantee
(Appeal Bond Surety Guarantee)
MR0074 Appeal Bond Escrow Deposit
(Appeal Bond escrow Account)
MR0370 Coal Completion Report
(Coal Completion Report)
MR0405 Surety Bond-Mining (General)
(General Surety Bond)
MR0406 Collateral Bond-Mining (General)
(General Collateral Bond)
MR0407 Collateral Bond-Mining (Subsidence)
(Subsidence Collateral Bond)
MR0408 Surety Bond-Mining (Subsidence)
(Subsidence Surety Bond)
MR0409 Assignment of Certificate of Deposit Under Collateral Bonding-Mining
(CD Assignment)
MR0410 Mining Bond Amendment - Permit Acres
(Bond Amendment)
MR0411 Partial Replacement of Collateral Under Collateral Bond
(Partial Replacement of Collateral Bond)
MR0412 Schedule for Deposit of Collateral Under Collateral Bond-Mining
(Schedule for Deposit of Collateral Bond)
MR0414 Loan Agreement for Emergency Bond Fund Applicant
(Emergency Bond Fund Loan Agreement)
MR0436 Conventional Bonding for Land Reclamation Annual Bond Calculation Summary
(Annual Bond Calculation)
MR0451 Cost Comparisons and Bond Calculation for Existing and Replacement Supplies

Industrial Minerals
Form No. Title File Format
MR0004 Registration Application for Short Term Construction Projects BMR-GP-103
(Short Term Construction Projects)
MR0050 Contractual Consent Of Landowner (Noncoal/Industrial Minerals)
(Contractual Consent of Landowner)
MR0054 GP-101 General Permit for the construction, operation and maintenance of a temporary road across a watercourse
(Temporary Road Across)
MR0059 General Permit for the construction, operation and maintenance of an access road across a watercourse
(Operation Maintenance of Access Road)
MR0094 Mine Employment and Production Report
(Employment and Production Report)
MR0151 Noncoal Notice of Intent to Explore (Drilling Only)
(Noncoal Notice of Intent to Explore)
MR0152 Noncoal Exploration Request for Permit Waiver
(Noncoal Exploration Request for Permit Waiver)
MR0304 Bonding Increment Application and Authorization to Conduct Noncoal Mining Activities
(Bond Increment Application)
MR0315 Large Noncoal (Industrial Minerals) Mine Permit Application
(Permit Large Noncoal Mine)
BMP0316 Permit Application for a Small Noncoal (Industrial Minerals) Surface Mine
(Permit Small Noncoal Mine)
MR0344 Bluestone Small Noncoal (Industrial Mineral) Surface Mine Permit Application
(Permit Bluestone Small Noncoal)
MR0387 E&S Plan for Small Noncoal application in special protection watersheds
(
Small Noncoal application in special protection watersheds)

Water Supply
Form No. Title File Format
MR0110 Consent to Lesser Water Supply Agreement
MR0111 Abandonment of Water Supply Agreement
MR0445 Release of the Obligation to Pay Increased Operation and Maintenance Costs for an Affected Water Supply
MR0451 Cost Comparisons and Bond Calculation for Existing and Replacement Supplies

Coal Ash Beneficial Use
Form No. Title File Format
MR0011 Coal Ash Beneficial Use Certification Application
(Coal Ash Beneficial Use Certification Application)
MR0012 Coal Ash Quality Assessment for Beneficial Use
(Coal Ash Quality Assessment for Beneficial Use)
MR0014 Coal Ash Water Quality Monitoring Report
(Coal Ash Water Quality Monitoring Report)
MR0149 Contractual Consent of Landowner for Beneficial Use of Coal Ash
(Contractual Consent of Landowner for Beneficial Use of Coal Ash)

 

Bureau of Mining Programs District Mining Operations Bureau of Mine Safety Bureau of Abandoned Mine Reclamation