Information Collection

Pre-Post Mine Worker Survey

IC 216919 under ICR 201505-0920-010 · OMB 0920-1094.

Documents and Forms

Document Name Document Type
Pre-Post Mine Worker Survey Form
Pre/Post Mine Worker Survey Att C_Pre-Post PDM Worker Survey_Paper Version.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pre-Post 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Pre/Post Mine Worker Survey	Att C_Pre-Post PDM Worker Survey_Paper Version.docx		Yes	No	Paper Only

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: 0 %

	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

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.