National Survey of the Mining Population

Documents and Forms

Document Name Document Type
National Survey of the Mining Population Form and Instruction
National Survey of the Mining Population Questionnaire Appendix J Questionnaire Rev 10 NIOSH.doc Form and Instruction
Appendix I Cover letter2 Sig.doc Cover Letter to Respondent Mines IC Document
Appendix K Access Internet Survey.doc Instructions for Accessing the Internet Version of the Questionnaire IC Document
Appendix L QA Brochure.doc Questions and Answers Brochure IC Document
Appendix M Phone Scripts.doc Telephone Scripts for Initial and Follow-up Contact with Respondents IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Survey of the Mining Population	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	National Survey of the Mining Population Questionnaire	Appendix J Questionnaire Rev 10 NIOSH.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,648	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,648	1,648
Annual IC Time Burden (Hours)	3,296	3,296
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cover Letter to Respondent Mines	Appendix I Cover letter2 Sig.doc	04/25/2007
Instructions for Accessing the Internet Version of the Questionnaire	Appendix K Access Internet Survey.doc	04/25/2007
Questions and Answers Brochure	Appendix L QA Brochure.doc	04/25/2007
Telephone Scripts for Initial and Follow-up Contact with Respondents	Appendix M Phone Scripts.doc	04/25/2007

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