Participant Demographic Information Collection Form

Demographic Information Collection for MSHA Grants

Documents and Forms

Document Name Document Type
Form MSHA Form xxxx Participant Demographic Information Collection Form Form and Instruction
MSHA Form xxxx Participate Demographic Information Collection Form Participant Demographic Information Collection Form 4-15-2024.docx Form and Instruction
MSHA Form xxxx Participate Demographic Information Collection Form Participant Demographic Information Collection Form 5-21-2024.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Participant Demographic Information Collection Form	Agency IC Tracking Number:

Is this a Common Form? Yes		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	MSHA Form xxxx	Participate Demographic Information Collection Form	Participant Demographic Information Collection Form 5-21-2024.docx		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 650	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	650	650
Annual IC Time Burden (Hours)	33	33
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.