Phase II - Baseline Form

Field Evaluation of Prototype Kneel-Assist Devices in Low-Seam Mining

Documents and Forms

Document Name Document Type
Phase II - Baseline Form Form
Phase II Baseline Form Attachment_11_-_Phase_II_Baseline_Form.doc Form

Information Collection (IC) Details

IC Title:	Phase II - Baseline Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Phase II Baseline Form	Attachment_11_-_Phase_II_Baseline_Form.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 6

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	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.