Application for Waiver of Surface Facilities Requirements

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0024 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Application for Waiver of Surface Facilities Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 71.403 30 CFR 71.404 30 CFR 75.1712-4 30 CFR 75.1712-5

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 933	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	933	90	843
Annual IC Time Burden (Hours)	357	35	322
Annual IC Cost Burden (Dollars)	4,665	4,665	0

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