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Permitting & Operator Forms (Coal)

For a complete listing of Mineral Resources Management forms, refer to the Division's Forms & Documents library.

The majority of coal mining application forms have been removed from the Division’s website due to a full transition to the Coal Electronic Processing System (EPS). Forms may be accessed from inside Coal EPS under the left hand navigation pane under Coal Forms. Access to the Coal EPS requires an account to create and manage coal mining permitting applications. The account request form is available in the EPS section below. If you are having trouble locating a particular form in the Coal EPS, please contact the permitting section at (614) 265-6633 or (740) 439-9079.

Electronic Processing System (EPS)

EPS Account Request (.DOC)

EPS Consulting Company Authorization (.DOC)

EPS Required Copies Checklist (.DOC) 

EPS Submit Authorization (.DOC) 

EPS Consulting Company Request for NPDES_QMR (.DOC)


Centralized Ownership and Control File (.DOC)

Certificate of Insurance (.DOC)

Signature Authorization Letter Example (.PDF)

Statutory Agent Addendum (.DOC)

Blaster Certification

Blaster Certification Application (.PDF)

Blaster Certification Renewal Application (.PDF)


Collateral Bond Indemnity Agreement (.DOC)

CBIA Federal Lands Under State Permits (.DOC)

Irrevocable Standby Letter of Credit (.DOC)

Notification of Election of Performance Security - DNR 744-9078 (.DOC)

Reallocation of Surety Bond Incidental Boundary Revision (.DOC)

Surety Bond Number (.DOC)

Validation of Collateral Bond (.DOC)

Validation of Surety Bond (.DOC)


EPS Applicant & Technical Reviewer Guidelines for ARPs (.DOC)

CCB General Guidelines (.DOC)

CCB Hydrologic Guidelines (.DOC)

CCB Soil Guidelines (.DOC)

Stream Buffer Zone Variance Request Guidelines (.PDF)

Operator Forms

Annual Final Report (.DOC)

Certification of Impoundment Construction (.DOC)

Certification of Sediment Control System Construction (.DOC)

Engineer's Annual Impoundment Certification (.DOC)

Monthly Report - Form 4500 (.DOC)

Monthly Report - Form EPA-4110 (.DOC)

Notification of Temporary Cessation of Operations (.DOC)

Operator's Request for Bond Release for Reaffected Area - SM-39 (.DOC)

Operator's Notification of Completion of Prime Farmland Resoiling (.DOC)

Planting Report (.DOC)

Quarterly Monitoring Report (.XLS)

Request for an Extension of Time Beyond 90 Days for NOV (.DOC)

Phase 1: Request for Approval of Backfilling and Grading (.DOC)

Phase 2: Request for Approval of Resoiling and Revegetation (.DOC)

Phase 3: Request for Approval of Successful Reclamation (.DOC)

Request to Remove Siltation Structures / Termination of 2-Year Period (.DOC)

Verification of Proper Planting of Tree Seedlings Form (.DOC)

Yield Report Form (.DOC)