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Mine Worker Oral Consent Script
Assessing the Impact of Organizational and Personal Antecedents on Proactive Health/Safety Decision Making
OMB: 0920-1104
IC ID: 217542
OMB.report
HHS/CDC
OMB 0920-1104
ICR 201605-0920-010
IC 217542
( )
Documents and Forms
Document Name
Document Type
Attachment F_Mine Worker Oral Consent Script.docx
Other-WORD
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Mine Worker Oral Consent Script
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-WORD
Attachment F_Mine Worker Oral Consent Script.docx
No
Fillable Fileable
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:
600
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
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
600
0
200
0
0
400
Annual IC Time Burden (Hours)
50
0
17
0
0
33
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.