Mine Worker Survey

Assessing the Impact of Organizational and Personal Antecedents on Proactive Health/Safety Decision Making

Documents and Forms

Document Name Document Type
Att D_Mine Worker Survey_Screen Shots.docx Other-Screenshots
Attachment C_Mine Worker Survey_Paper.docx Other-WORD

Information Collection (IC) Details

IC Title:	Mine Worker Survey	Agency IC Tracking Number:	16ALP

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
Other-Screenshots			Att D_Mine Worker Survey_Screen Shots.docx		Yes	Yes	Fillable Printable
Other-WORD			Attachment C_Mine Worker Survey_Paper.docx		Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	600	200	400
Annual IC Time Burden (Hours)	150	50	100
Annual IC Cost Burden (Dollars)	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.