Information Collection

Respirable Coal Mine Dust Sampling

IC 43812 under ICR 202503-1219-004 · OMB 1219-0011.

Documents and Forms

Document Name Document Type
Form MSHA-NA Respirable Coal Mine Dust Sampling Form
Form MSHA-NA Mine Operator Coal Dust Operator Data Card 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 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 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 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 90.208(d), (f) 30 CFR 71.207(a), (c), (d), (f) 30 CFR 70.211(b), (c) 30 CFR 71.208(b), (c) 30 CFR 71.300(a), (a)(1), (a)(3) 30 CFR 90.300(a) 30 CFR 71.301(d)(1), (d)(3), (e) 30 CFR 70.210(a), (c), (d), (f) 30 CFR 90.301(d), (e) 30 CFR 70.205(b)(2); 71.205(b)(2) 30 CFR 90.201(f), (g), (j) 30 CFR 90.209(b), (c); 30 CFR 70.201(b)(2),(e),(f),(g),(j) 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 71.201(a), (d), (e); (f)

Information Collection 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 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

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 701	Number of Respondents for Small Entity: 550

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

Percentage of Respondents Reporting Electronically: 60 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	989,403	-5,699	995,102
Annual IC Time Burden (Hours)	69,765	11,506	58,259
Annual IC Cost Burden (Dollars)	29,813	-22	29,835

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.

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