Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Coal Miner Radiograph (CWHSP) Unchanged 14560 3640 0 Instruction
Instruction
Chest Radiograph Classification (CDC/NIOSH Form 2.8) Unchanged 30140 1507 0 Form 2.8 Chest Radiograph Classification
Form 0920-0020 Chest Radiograph Classification Form M 2.8 25MAR2019
Coal Contractor Plan CDC/NIOSH 2.18 Unchanged 575 288 0 Form 2.18 Coal Contractor Plan
Coal Mine Operator's Plan (CDC/NOISH (M) 2.10) Unchanged 388 194 0 Form 2.10 Coal Mine Operator's Plan
Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6) Unchanged 1 0 0 Form 2.6 Consent, Release and History Form for Autopsy
Invoice-Pathologist Unchanged 1 0 0 Instruction
Miner Identification Document (CDC/NIOSH 2.9) Unchanged 14560 4854 0 Form 2.9 Miner Identification Document
Form 2.9 Miner Identificaiton Document
Form 0920-0020 Miner Identification Document Form M 2.9 25MAR2019
Physician Application for Certification (CDC/NIOSH 2.12) Unchanged 80 13 0 Form and Instruction 2.12 Physician Application for Certification
Radiographic Facility Certification (CDC/NIOSH (M) 2.11) Unchanged 40 20 0 Form 2.11 Radiographic Facility Certification
Report - Pathologist Unchanged 1 0 0 Instruction
Spirometry Facility Employee - Respiratory Assessment 2.13 Unchanged 14560 1214 0 Form 2.13 Respiratory Assessment
Spirometry Facility Supervisor - Certification Document 2.14 Unchanged 100 50 0 Form 2.14 Spirometry Facility Certification
Spirometry Results Notification CDC/NIOSH 2.15 Unchanged 14560 4854 0 Form 2.15 Spirometry Results Notification form edit
Spirometry Test for Coal Miners Unchanged 14560 3640 0 Instruction
Total burden requested under this ICR: 104126 20274 0  
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