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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Coal Mine Operator's Plan
Modified
200
100
0
Form and Instruction
CDC/NIOSH (M) 2.9
Miner Identification Document
Form and Instruction
CDC/NIOSH (M) 2.10
Coal Mine Operator's Plan
Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
Modified
50
4
0
Form
5
Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
Form
6
Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist
Modified
50
4
0
Form
5
Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
Form
6
Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
Form and Instruction
9
Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist
Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kin (form 2.6)
Modified
50
13
0
Form
5
Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
Coal Workers' Health Surveillance Program (CWHSP)-Spirometry Test
Modified
2500
833
0
Form
5
Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
Form
6
Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
Form and Instruction
9
Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist
Form
none
Spirometry
Coal Workers' Health Surveillance Program (CWHSP)-X-ray Coal Miners
Modified
5000
1250
0
Form
5
Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
Form
6
Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
Form and Instruction
9
Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist
Facility Certification Document
Modified
100
50
0
Form and Instruction
CDC/NIOSH (M) 2.9
Miner Identification Document
Form and Instruction
CDC/NIOSH (M) 2.10
Coal Mine Operator's Plan
Form and Instruction
CDC/NIOSH (M) 2.11
Facility Certification Document
Form
4
Facility Certification Document
Interpretating Physician Certification Document
Modified
300
50
0
Form and Instruction
CDC/NIOSH (M) 2.9
Miner Identification Document
Form and Instruction
CDC/NIOSH (M) 2.10
Coal Mine Operator's Plan
Form and Instruction
CDC/NIOSH (M) 2.11
Facility Certification Document
Form and Instruction
CDC/NIOSH (M) 2.12
Facility Certification Document
Miner Identification Document
Modified
5000
1667
0
Form and Instruction
CDC/NIOSH (M) 2.9
Miner Identification Document
Roentgenographic Interpretation
Modified
10000
500
0
Form and Instruction
Form No 2.8
rointgenographic interpretation form
Total burden requested under this ICR:
23250
4471
0
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