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OMB Control No: 1219-0024	ICR Reference No: 202512-1219-003
Status: Received in OIRA	Previous ICR Reference No: 202303-1219-002
Agency/Subagency: DOL/MSHA	Agency Tracking No: 10/31/26 Exp
Title: Application for Waiver of Surface Sanitary Facilities’ Requirements (Pertaining to Coal Mines)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 08/26/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	612	186
Time Burden (Hours)	86	74
Cost Burden (Dollars)	1,020	930

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	612	186	426
Annual Time Burden (Hours)	86	74	12
Annual Cost Burden (Dollars)	1,020	930	90

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Number of Respondents: The number of respondents increased from 186 to 204 due to an increase in the number of coal mine operators applying for extensions of existing waivers. Number of Responses: The number of responses increased from 186 to 612 due to the increase in the number of coal mine operators applying for extensions of existing waivers. Annual Time Burden: The number of burden hours increased from 74 to 86 due to an increase in the number of responses. Annual Recordkeeping Costs: The estimated annual cost increased from $930 to $1,020 due to the increase in the number of responses.

Annual Cost to Federal Government: $1,629

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Joanna Moore 202 693-9825 moore.joanna@dol.gov

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