Nonresponse Survey

Form Approved

OMB No. 0920-xxxx

Exp. Date: xx/xx/20xx

Mining Industry and Workforce

Nonresponse Survey

(COMMODITY) Mines

Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Office of Mine Safety and Health Research 626 Cochrans Mill Road Pittsburgh, Pennsylvania 15236

Mining Industry and Workforce Nonresponse Survey

The Mining Industry and Workforce Survey was conducted between MM/DD/YYYY and MM/DD/YYYY and MINE NAME (MINE ID) was selected to represent (SECTOR) mines. We did not receive your mine’s completed survey for the Mining Industry and Workforce Survey and would like to know why your mine did not return it. We would be very grateful for your answers to these questions and your improvement suggestions. Thank you in advance.

1. Please mark all of the reasons that apply for why your mine did not return the survey.

 We did not receive the survey

 We were unable to complete the survey by the deadline

 Company did not approve participation

 Completing the survey would take too much time

 We do not have staff for this type of request

 Other (please specify)

2. From April 1 to June 30, 20xx, please describe how this mine was operated.

       Mine operator is a direct employee of the mine

       Mine operator is an independent contractor and was retained to supervise the mine’s employees and operations

        Mine operator is an employee of an outside company which also provides workforce for the mine

3. From April 1 to June 30, 20XX, what was your mine’s status? Select the single most accurate mine status.

 Full-time permanent

 Intermittent (including seasonal)

 Non-producing

 Permanently abandoned

4. Did one or more employees work at the mine at any time between April 1 and June 30, 20XX?

 No

 Yes

5. How could we make participation easier?

Thank you for completing this survey.

Please place it in the enclosed postage-paid envelope or mail it to:

(VENDOR)

Address

City, State Zip

If you have questions, please call (VENDOR), the survey contractor, at XXX-XXX-XXXX.

CDC estimates the average public reporting burden for this collection of information as 10 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia, 30333; ATTN: PRA (0920-xxxx)