View Information Collection (IC)

View Information Collection (IC)

IC Title:	Radiation Sampling and Exposure Records	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 57.5037 30 CFR 57.5040

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Individual Exposure to Radon Daughters	4000-9	4000-9 Individual Exp to Radon Daughters (Feb 11) OMB.pdf	http://www.msha.gov/forms/elawsforms/40009.htm	Yes	Yes	Fillable Fileable Signable

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: 5	Number of Respondents for Small Entity: 0

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	505	0	0	405	0	100
Annual IC Time Burden (Hours)	502	0	0	-298	0	800
Annual IC Cost Burden (Dollars)	25	0	0	25	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.