Information Collection

Assessing the Safety Culture of Underground Coal Mining Structured Interview

IC 191084 under ICR 201210-0920-005 · OMB 0920-0835.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Assessing the Safety Culture of Underground Coal Mining Structured Interview	Form
Behavior Checklists Attachment C4 - Behavioral Checklists 7.24.12.doc	Form
Phase D, Structured Interview Questions Database Attachment C2 -Structured Interv Questions 7.24.12.doc	Form
Phase D, Behavioral Anchored Rating Scales (BARS) Attachment C3- Behavioral anchored rating scales.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	None	Behavior Checklists	Attachment C4 - Behavioral Checklists 7.24.12.doc	No	No	Paper Only
Form	None	Phase D, Structured Interview Questions Database	Attachment C2 -Structured Interv Questions 7.24.12.doc	No	No	Paper Only
Form	None	Phase D, Behavioral Anchored Rating Scales (BARS)	Attachment C3- Behavioral anchored rating scales.doc	No	No	Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 201

Number of Respondents for Small Entity: 10

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	Previously Approved
Annual Number of Responses for this IC	201	21	180
Annual IC Time Burden (Hours)	201	21	180
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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