Information Collection

Initial Telephone Screening contact with coal mines

IC 192719 under ICR 201004-0920-012 · OMB 0920-0862.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix G Telephone Script .doc	Instruction
Appendix K Pre-Notification Letter .doc Appendix K Notification Letter	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
Instruction					No	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 300

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix K Notification Letter		04/05/2010

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

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