OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Assessing the Safety Culture of Underground Coal Mining Survey

IC 191085 under ICR 201210-0920-005 · OMB 0920-0835.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Attachment C1 - Oral Consent Script Survey 10 9 12.doc Other-Oral Consent Script-Survey
Attachment D - Instructions to Respondents 7.24.12.doc Instruction
Demographic Sheet
Attachment C6- Demographic Sheet.doc 		Form
Safety Culture Survey
Attachment C5 - Safety Culture Survey 7.24.12.doc 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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
Other-Oral Consent Script-Survey Attachment C1 - Oral Consent Script Survey 10 9 12.doc No No Paper Only
Instruction Attachment D - Instructions to Respondents 7.24.12.doc No No Paper Only
Form None Demographic Sheet Attachment C6- Demographic Sheet.doc No No Paper Only
Form and Instruction None Safety Culture Survey Attachment C5 - Safety Culture Survey 7.24.12.doc No No Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,144 0 244 0 0 900
Annual IC Time Burden (Hours) 381 0 81 0 0 300
Annual IC Cost Burden (Dollars) 0 0 0 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.