Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Chest Radiograph Classification (CDC/NIOSH Form 2.8) Modified 10000 500 0 Form CDC/NOISH (M) 2.8 Chest Radiograph Classification
Coal Mine Operator's Plan (CDC/NOISH (M) 2.10) Modified 200 100 0 Form and Instruction CDC/NOISH (M) 2.10 Coal Mine Operator's Plan
Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6) Modified 5 1 0 Form CDC/NIOSH 2.6 Consent, Release and History Form
Facility Certification Document (CDC/NIOSH (M) 2.11) Modified 100 50 0 Form CDC/NOISH (M) 2.11 Facility Certification Document
Invoice-Pathologist (CWHSP) Modified 5 0 0 Instruction
Instruction
Miner Identification Document (CDC/NIOSH 2.9) Modified 5000 1667 0 Form and Instruction CDC/NOISH (M) 2.9 Miner Identification Document
Physician Application for Certification (CDC/NIOSH (M) 2.12) Modified 100 17 0 Form CDC/NIOSH (M) 2.12 Physical Application for Certification
Report Pathologist (CWHSP) Modified 5 0 0 Instruction
Spirometry Test for Coal Miners Modified 2500 833 0 Instruction
X-ray Coal Miners (CWHSP) 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
Total burden requested under this ICR: 22915 4418 0  
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