Information Collection

Mine Worker Survey

IC 214925 under ICR 201502-0920-005 · OMB 0920-1082.

Documents and Forms

Document Name Document Type
Mine Worker Survey Form and Instruction
Mine Worker Survey - Paper Version Attachment C.docx Form and Instruction
Mine Worker Survey - Electronic/Screenshots Attachment D.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Mine Worker Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Mine Worker Survey - Paper Version	Attachment C.docx	None	No		Paper Only
Form and Instruction	None	Mine Worker Survey - Electronic/Screenshots	Attachment D.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	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.