App G_Preliminary Survey for Boot Wear Evaluation

Ingress/Egress and Work Boot Outsole Wear Investigation at Surface mines

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1125 can be found here:

Documents and Forms

Document Name Document Type
Appendix G.docx Other-WORD
Appendix M.docx App M_Informed Consent IC Document

Information Collection (IC) Details

IC Title:	App G_Preliminary Survey for Boot Wear Evaluation	Agency IC Tracking Number:	16GK

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-WORD			Appendix G.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

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	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
App M_Informed Consent	Appendix M.docx	05/20/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.