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  
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