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Demographic Questionnaire (Mine Employee, Safety Professional, Student)
Enhancing Mine Workers Abilities to Identify Hazards at Sand, Stone, and Gravel Mines
OMB: 0920-1121
IC ID: 220555
OMB.report
HHS/CDC
OMB 0920-1121
ICR 201603-0920-005
IC 220555
( )
Documents and Forms
Document Name
Document Type
Form 0920-15XT
Demographic Questionnaire (Mine Employee, Safety Professional, Student)
Form and Instruction
0920-15XT Att C Demographic Questionaire
Att C Demographic Questionaire.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Demographic Questionnaire (Mine Employee, Safety Professional, Student)
Agency IC Tracking Number:
15XT
Is this a Common Form?
No
IC Status:
New
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 and Instruction
0920-15XT
Att C Demographic Questionaire
Att C Demographic Questionaire.docx
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Worker Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
31
Number of Respondents for Small Entity:
31
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
31
0
31
0
0
0
Annual IC Time Burden (Hours)
3
0
3
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.