Information Collection

Hazardous Conditions Complaints

IC 14363 under ICR 201309-1219-001 · OMB 1219-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0014 can be found here:

Documents and Forms

Document Name Document Type
Hazardous Conditions Complaints Form and Instruction
Hazardous Conditions Compliant 1219-0014 Collection Instrument.docx www.msha.gov/codeaphone/codeaphonenew.htm Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Hazardous Conditions Complaints	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 30 CFR 43.7 30 CFR 43.4

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Hazardous Conditions Compliant	1219-0014 Collection Instrument.docx	http://www.msha.gov/codeaphone/codeaphonenew.htm	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,431	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 96 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,431	153	2,278
Annual IC Time Burden (Hours)	486	30	456
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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