Information Collection

Mine Worker Survey

IC 214925 under ICR 201502-0920-005 · OMB 0920-1082.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Mine Worker Survey	Form and Instruction
Mine Worker Survey - Paper Version Attachment C.docx	Form and Instruction
Mine Worker Survey - Electronic/Screenshots Attachment D.docx	Form and Instruction

IC Title:

Mine Worker Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
Form and Instruction	None	Mine Worker Survey - Paper Version	Attachment C.docx	None	No		Paper Only
Form and Instruction	None	Mine Worker Survey - Electronic/Screenshots	Attachment D.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	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.