Att D_Mine Workers Survey

Assessing the Impact of Organizational and Personal Antecedents on Proactive Health/Safety Decision Making

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1104 can be found here:

Documents and Forms

Document Name Document Type
Att D_Mine Worker Survey_Screen Shots.docx Other-Screenshots
Attachment C_Mine Worker Survey_Paper.docx Other-WORD

Information Collection (IC) Details

IC Title:	Att D_Mine Workers 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
Other-Screenshots			Att D_Mine Worker Survey_Screen Shots.docx		Yes	Yes	Fillable Printable
Other-WORD			Attachment C_Mine Worker Survey_Paper.docx		Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	100	100
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.