General Preference Questionnaire

Assessing and Evaluating Human Systems Integration Needs in Mining

Documents and Forms

Document Name Document Type
General Preference Questionnaire Form and Instruction
Reformatted General Preference Questionnaire.docx Other-WORD
General Preference Questionnaire Appendix G_General Preference Questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	General Preference Questionnaire	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	General Preference Questionnaire	Appendix G_General Preference Questionnaire.docx		Yes	No	Paper Only
Other-WORD			Reformatted General Preference Questionnaire.docx		No	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	13	13
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.