Radiation Sampling and Exposure Records

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0003 can be found here:

Documents and Forms

Document Name Document Type
Form Individual Exposur Radiation Sampling and Exposure Records Form
Individual Exposur 4000-9 4000-9 Individual Exp to Radon Daughters (Feb 11) OMB.pdf www.msha.gov/forms/elawsforms/40009.htm Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Radiation Sampling and Exposure Records	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 57.5037 30 CFR 57.5040

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Individual Exposure to Radon Daughters	4000-9	4000-9 Individual Exp to Radon Daughters (Feb 11) OMB.pdf	http://www.msha.gov/forms/elawsforms/40009.htm	Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	505	405	100
Annual IC Time Burden (Hours)	502	-298	800
Annual IC Cost Burden (Dollars)	25	25	0

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.