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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Coal Miner Radiograph (CWHSP)
Modified
8500
2125
0
Instruction
Instruction
Authorization for Payment of Autopsy
New
4
1
0
Form
2.19
Authorization for Payment of Autopsy
B Reader Chest Radiograph Classification (CDC/NIOSH Form 2.8)
Modified
17600
880
0
Form
2..8
Chest radiographic classification form
Coal Contractor Plan (CDC/NIOSH 2.18)
Modified
160
80
0
Form
2.18
Coal contractor plan
Coal Mine Operator's Plan (CDC/NIOSH 2.10)
Modified
220
110
0
Form
2.10
Coal mine operator form
Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6)
Modified
4
1
0
Form
2.6
Consent, Release and History Form
Invoice-Pathologist
Modified
4
0
0
Instruction
Miner Identification Document (CDC/NIOSH 2.9)
Modified
8500
2833
0
Form
2.9
Miner identification form
Physician Application for Certification (CDC/NIOSH 2.12)
Modified
220
37
0
Form and Instruction
2.12
Physician Application for Certification
Radiographic Facility Certification (CDC/NIOSH 2.11)
Modified
20
10
0
Form
2.11
Radiograph Facility Certification
Report - Pathologist
Modified
4
0
0
Instruction
Spirometry Facility Employee - Respiratory Assessment 2.13
Modified
8500
709
0
Form
2.13
Respiratory assessment
Spirometry Facility Supervisor - Certification Document 2.14
Modified
15
8
0
Form
2.14
Spirometry Facility Certification
Spirometry Results Notification (CDC/NIOSH 2.15)
Modified
8500
2834
0
Form
2.15
Spirometry Results Notification
Spirometry Test for Coal Miners
Modified
8500
2125
0
Instruction
Total burden requested under this ICR:
60751
11753
0
To view an IC, click on IC Title