Initial Telephone Screening contact with coal mines

Survey of Coal Mine Safety Interventions

Documents and Forms

Document Name Document Type
Appendix G Telephone Script .doc Instruction
Appendix K Pre-Notification Letter .doc Appendix K Notification Letter IC Document

Information Collection (IC) Details

IC Title:	Initial Telephone Screening contact with coal mines	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
Instruction			Appendix G Telephone Script .doc		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 %

	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

Title	Document	Date Uploaded
Appendix K Notification Letter	Appendix K Pre-Notification Letter .doc	04/05/2010

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