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Federal forms, ICRs, and supporting documents

Information Collection Request

Ingress/Egress and Work Boot Outsole Wear Investigation at Surface mines

ICR 201906-0920-012 · OMB 0920-1125 · Active

Forms and Documents
DocumentTypeStatusAvailability
Supporting_statement_Part_B_.docx Supporting Statement B Uploaded 2019-06-27 Available
Appendix O_IRB (BootOutsoleWear).docx Supplementary Document Uploaded 2019-06-27 Available
Appendix N_IRB (Ingress-EgressStudy).docx Supplementary Document Uploaded 2019-06-27 Available
Appendix B_60dyFRN (published).pdf Supplementary Document Uploaded 2019-06-27 Available
Appendix A_Authorizing Legislation.docx Supplementary Document Uploaded 2019-06-27 Available
Supporting_statement_Part_A.docx Supporting Statement A Uploaded 2019-06-27 Available
IC Document Collections
IC IDCollectionTypeStatusForm
221627 App L_Informed Consent form (Longitudinal boot outsole study) Other-WORD Unchanged
221626 App J_Talent and Consent Waiver Other-WORD Unchanged
221624 App I_Final Survey for Boot Wear Evaluation Other-WORD Unchanged
221623 App H_Survey for Recording Period for Boot Wear Evaluation (On-going) Other-WORD Unchanged
221622 App G_Preliminary Survey for Boot Wear Evaluation Other-WORD Unchanged
221621 App F_Screening Questionnaire Other-WORD Unchanged
221618 App E_Mine management interview guide Other-WORD Unchanged
221617 App D_Mobile equipment operator interview guide Other-WORD Unchanged
221614 App C_Mobile equipment operator focus group guide Other-WORD Unchanged
ICR Details
0920-1125 201906-0920-012
Active 201605-0920-011
HHS/CDC 0920-1125
Ingress/Egress and Work Boot Outsole Wear Investigation at Surface mines
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 03/12/2020
Retrieve Notice of Action (NOA) 08/02/2019
  Inventory as of this Action Requested Previously Approved
03/31/2022 24 Months From Approved
3,100 0 0
643 0 0
0 0 0
Slips and falls of a person are the second largest contributor to non-fatal injuries in the U.S. mining industry. The objective of this work is to investigate how ingress egress systems on mobile equipment and personal protective footwear (boots) used by miners may lead to slips, trips and falls at stone, sand and gravel surface mining facilities.
PL: Pub.L. 95 - 164 2 Name of Law: Federal Mine Safety and Health Act of 1977
  
None
Not associated with rulemaking
  84 FR 10313 03/20/2019
84 FR 35866 07/25/2019
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,100 0 0 0 0 3,100
Annual Time Burden (Hours) 643 0 0 0 0 643
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$137,000
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Thelma Sims 4046394771
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/02/2019