Information Collection

Respirable Coal Mine Dust Sampling

IC 43812 under ICR 202402-1219-001 · OMB 1219-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MSHA-NA Respirable Coal Mine Dust Sampling	Form
White Card Egov UI prototype.pdf www.msha.gov/support-resources/forms-online-filing/2020/10/01/electronic-mine-operator-dust-data-card	Other-Electronic Mine Operator Dust
White Card Egov UI prototype.pdf www.msha.gov/support-resources/forms-online-filing/2020/10/01/electronic-mine-operator-dust-data-card	Other-Electronic Mine Operator Dust
INTRO Electronic Mine Operator Dust Data Card 1219-0011.pdf www.msha.gov/support-resources/forms-online-filing/2020/10/01/electronic-mine-operator-dust-data-card	Instruction
INTRO Electronic Mine Operator Dust Data Card 1219-0011.pdf www.msha.gov/support-resources/forms-online-filing/2020/10/01/electronic-mine-operator-dust-data-card	Instruction
MSHA-NA Mine Operator Coal Dust Operator Data Card Front_and_Back_of_Dust_Data_card.pdf	Form
MSHA-NA Mine Operator Coal Dust Operator Data Card Front_and_Back_of_Dust_Data_card.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Respirable Coal Mine Dust Sampling

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 71.301(d)(1), (d)(3), (e) 30 CFR 90.300(a) 30 CFR 90.301(d), (e) 30 CFR 70.205(b)(2); 71.205(b)(2) 30 CFR 75.370(a)(3)(i)(a3iii)(f1,f3) 30 CFR 90.207(c)(3), (f)(3) 30 CFR 70.212(a); 71.209(a); 90.210 30 CFR 70.210(a), (c), (d), (f) 30 CFR 71.300(a), (a)(1), (a)(3) 30 CFR 71.207(a), (c), (d), (f) 30 CFR 70.211(b), (c) 30 CFR 71.208(b), (c) 30 CFR 90.208(d), (f) 30 CFR 70.208(e)(3), (h)(3), (i)(2) 30 CFR 70.209(c)(3), (f)(3), (g)(2) 30 CFR 71.206(d), (e), (h)(3), (k)(3) 30 CFR 70.201(b)(2),(e),(f),(g),(j) 30 CFR 90.201(f), (g), (j) 30 CFR 90.209(b), (c); 30 CFR 71.201(a), (d), (e); (f)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	MSHA-NA	Mine Operator Coal Dust Operator Data Card	Front_and_Back_of_Dust_Data_card.pdf		No		Paper Only
Other-Electronic Mine Operator Dust Data Card			White Card Egov UI prototype.pdf	https://www.msha.gov/support-resources/forms-online-filing/2020/10/01/electronic-mine-operator-dust-data-card	Yes	Yes	Fillable Fileable
Instruction			INTRO Electronic Mine Operator Dust Data Card 1219-0011.pdf	https://www.msha.gov/support-resources/forms-online-filing/2020/10/01/electronic-mine-operator-dust-data-card	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 676

Number of Respondents for Small Entity: 507

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 60 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	995,102	995,102
Annual IC Time Burden (Hours)	58,259	58,259
Annual IC Cost Burden (Dollars)	29,835	29,835

Documents for IC

table that charts IC Documents
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.