Information Collection

Risk Assessment Measure (Mine Workers, Safety Professional, Student)

IC 220557 under ICR 201603-0920-005 · OMB 0920-1121.

Documents and Forms

Document Name Document Type
Form 0920-15XT Risk Assessment Measure (Mine Workers, Safety Professional, Student) Form and Instruction
0920-15XT Att E Risk Assessment Att E Risk Assessment.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Risk Assessment Measure (Mine Workers, Safety Professional, Student)	Agency IC Tracking Number:	15XT

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	0920-15XT	Att E Risk Assessment	Att E Risk Assessment.docx		No		Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 31	Number of Respondents for Small Entity: 31

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	31	31
Annual IC Time Burden (Hours)	10	10
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.