Radiation Sampling and Exposure Records

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form MSHA 4000-9 Record of Individual Exposure to Radon Daughters	Form and Instruction	Modified	Repair queued
Form MSHA 4000-9 Record of Individual Exposure to Radon Daughters	Form and Instruction	Modified	Available
1219-0003 60-Day FRN Published 3-25-2026.pdf	Supplementary Document	Uploaded 2026-05-27	Repair queued
1219-0003 60-Day FRN Published 3-25-2026.pdf	Supplementary Document	Uploaded 2026-05-27	Available
1219-0003 Supporting Statement 2026.docx	Supporting Statement A	Uploaded 2026-05-27	Repair queued
1219-0003 Supporting Statement 2026.docx	Supporting Statement A	Uploaded 2026-05-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
14336	Radiation Sampling and Exposure Records	Form and Instruction	Modified	Record of Individual Exposure to Radon Daughters
14336	Radiation Sampling and Exposure Records	Form and Instruction	Modified	Record of Individual Exposure to Radon Daughters
14336	Radiation Sampling and Exposure Records	Other-Print to View PDF of MSHA Form 4000-9	Modified

ICR Details

OMB Control No: 1219-0003	ICR Reference No: 202512-1219-002
Status: Active	Previous ICR Reference No: 202502-1219-002
Agency/Subagency: DOL/MSHA	Agency Tracking No: 10/31/26 Exp
Title: Radiation Sampling and Exposure Records
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/05/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/26/2026
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2029	36 Months From Approved	10/31/2026
Responses	404	0	404
Time Burden (Hours)	402	0	402
Cost Burden (Dollars)	20	0	20

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Abstract: MSHA regulations require operators to maintain accurate records of employee exposures to potentially toxic materials or harmful physical agents which are required to be monitored or measured under any applicable mandatory health or safety standard promulgated under this Act. Airborne radon and radon daughters exist in every uranium mine and in several other underground mining commodities. Radon is radioactive gas. It diffuses into the underground mine atmosphere through the rock and the ground water. Radon decays in a series of steps into other radioactive elements, which are solids, called radon daughters. Radon and radon daughters are invisible and odorless. Decay of radon and its daughters results in emissions of alpha energy.

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Authorizing Statute(s): US Code: 30 USC 813(h) Name of Law: Federal Mine Safety & Health Act of 1977
   US Code: 30 USC 811 Name of Law: Federal Mine Safety & Health Act of 1977
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 14589	03/25/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 53656	08/19/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Radiation Sampling and Exposure Records	MSHA 4000-9	Record of Individual Exposure to Radon Daughters

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	404	404	0	0	0	0
Annual Time Burden (Hours)	402	402	0	0	0	0
Annual Cost Burden (Dollars)	20	20	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/26/2026

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