Information Collection

Radiation Sampling and Exposure Records

IC 14336 under ICR 201612-1219-004 · OMB 1219-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0003 can be found here:

Documents and Forms

Document Name Document Type
Form Individual Exposur 4000-9 Radiation Sampling and Exposure Records Form
Individual Exposur 4000-9 4000-9 Individual Exp to Radon Daughters (Apr 14) OMB.pdf arlweb.msha.gov/forms/elawsforms/40009.htm Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Radiation Sampling and Exposure Records	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 57.5037 30 CFR 57.5040

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Individual Exposure to Radon Daughters	4000-9	4000-9 Individual Exp to Radon Daughters (Apr 14) OMB.pdf	http://arlweb.msha.gov/forms/elawsforms/40009.htm	Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: DOL-MSHA 24, Radon Daughter Exposure	FR Citation: 67 FR 16815

Number of Respondents: 5	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	Previously Approved
Annual Number of Responses for this IC	505	505
Annual IC Time Burden (Hours)	502	502
Annual IC Cost Burden (Dollars)	25	25

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.

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