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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Chest Radiograph Classification (CDC/NIOSH Form 2.8)
Modified
20800
1040
0
Form
CDC/NOISH (M) 2.8
Chest Radiograph Classification
Coal Contractor Plan 2.18
New
383
192
0
Form
2.18
Coal Contractor Plan
Coal Mine Operator's Plan (CDC/NOISH (M) 2.10)
Modified
575
288
0
Form and Instruction
2.10
Coal 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
40
20
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
10383
3461
0
Form and Instruction
CDC/NOISH (M) 2.9
Miner Identification Document
Physician Application for Certification (CDC/NIOSH (M) 2.12)
Modified
50
8
0
Form
CDC/NIOSH (M) 2.12
Physical Application for Certification
Report Pathologist (CWHSP)
Modified
5
0
0
Instruction
Spirometry Facility Employee - Notification form 2.16
New
10383
1731
0
Form
2.16
Spriometry Notification
Spirometry Facility Employee - Respiratory Assessment 2.13
New
10383
865
0
Form
2.13
Respiratory Assessment
Spirometry Facility Supervisor - Certification Document 2.14
New
200
100
0
Form
2.14
Facility Certification
Spirometry Technician - Pre-test Checklist 2.15
New
10383
865
0
Form
2.15
Spirometry Pre-test Checklist
Spirometry Technician - Results Form 2.17
New
10383
1731
0
Form
2.17
Spirometry Results
Spirometry Test for Coal Miners
Modified
10383
3461
0
Instruction
X-ray Coal Miners (CWHSP)
Modified
10383
2596
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:
94744
16359
0
To view an IC, click on IC Title