Information Collection

30 CFR § 75.1321 and § 77.1909-1

IC 14382 under ICR 201304-1219-004 · OMB 1219-0025.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0025 can be found here:

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Information Collection (IC) Details

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IC Title:	30 CFR § 75.1321 and § 77.1909-1	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 77.1909-1 30 CFR 75.1321

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 67	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	67	-34	101
Annual IC Time Burden (Hours)	67	-12	79
Annual IC Cost Burden (Dollars)	201	-413	614

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.