Information Collection

250.867(a) - Request Approval safety system/device

IC 250212 under ICR 202410-1014-003 · OMB 1014-0003.

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Information Collection (IC) Details

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IC Title:	250.867(a) - Request Approval safety system/device	Agency IC Tracking Number:	1014-0003 ext' 25

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.867(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 14

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

Percentage of Respondents Reporting Electronically: 90 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20	0	20
Annual IC Time Burden (Hours)	80	-60	140
Annual IC Cost Burden (Dollars)	0	0	0

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