Phase II - 1,3,6 Months Form

Field Evaluation of Prototype Kneel-Assist Devices in Low-Seam Mining

Documents and Forms

Document Name Document Type
Phase II - 1,3,6 Months Form Form and Instruction
Phase II 1,3, and 6 months Forms Attachment_12_-_Phase_II_1_3_and_6_months_forms.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Phase II - 1,3,6 Months Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	none	Phase II 1,3, and 6 months Forms	Attachment_12_-_Phase_II_1_3_and_6_months_forms.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 6

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	324	324
Annual IC Time Burden (Hours)	135	135
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.