Information Collection

National Survey of the Mining Population

IC 180290 under ICR 200705-0920-009 · OMB 0920-0754.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.