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