Prescreening Questionnaire (Mine Emppoyee, Safety Professional, Student)

Enhancing Mine Workers Abilities to Identify Hazards at Sand, Stone, and Gravel Mines

Documents and Forms

Document Name Document Type
Prescreening Questionnaire (Mine Emppoyee, Safety Professional, Student) Form and Instruction
Pre-Screening Questionnaire 05JUL2016 Att D Pre Screening_OMB_bme docxclean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Prescreening Questionnaire (Mine Emppoyee, Safety Professional, Student)	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 and Instruction	NA	Pre-Screening Questionnaire 05JUL2016	Att D Pre Screening_OMB_bme docxclean.docx	NA	No		Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 43	Number of Respondents for Small Entity: 43

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	43	43
Annual IC Time Burden (Hours)	11	11
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.