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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
Form
CDC/NIOSH 2.8(E), Revised 01/2020
Chest Radiograph Classification
Authorization for Payment of Autopsy
Modified
4
1
0
Form
CWHSP 2.19, Dec 2020
Authorization for Payment of Autopsy
Chest Radiograph Classification - B Reader Physician
Modified
17600
880
0
Form
CDC/NIOSH (M) 2.8 REV 01/2020
Chest Radiograph Classification
Coal Contractor Plan CDC/NIOSH 2.18
Modified
160
80
0
Form
CDC/NIOSH (M) 2.18 (E), rev 01/2015
Coal Contractor Plan
Coal Mine Operator's Plan (CDC/NOISH (M) 2.10)
Modified
220
110
0
Form
CDC/NIOSH (M) 2.10 (E). rev 01/2015
Coal Mine Operator's Plan
Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6)
Modified
4
1
0
Form
CDC/NIOSH 2.6 (02/2015)
Consent, Release and History Form for Autopsy
Invoice-Pathologist
Modified
4
1
4
Form and Instruction
CWHSP 2.19, Dec 2020
Authorization for Payment of Autopsy
Miner Identification Document (CDC/NIOSH 2.9)
Modified
8500
2833
0
Form
CDC/NIOSH 2.9(E), Revised 02/2019
Miner Identification Document
Pathologist Report
New
4
1
4
Form
CWHSP 2.19, 12/2020
Authorization for Payment Autopsy
Physician Application for Certification (CDC/NIOSH 2.12)
Modified
220
37
0
Form
CDC 2.12 (E), Rev 02/2019
Physician Application for Certification
Radiographic Facility Certification (CDC/NIOSH (M) 2.11)
Modified
20
10
0
Form
CDC 2.11 (E), rev 02/2015
Radiographic Facility Certification
Respiratory Assessment Form - Spirometry Facility Employee
Modified
8500
708
0
Form
CDC/NIOSH 2.13 (E), rev 04/2016
Respiratory Assessment Form
Spirometry Facility Certification Form
Modified
15
8
0
Form
CDC/NIOSH 2.14 (E), rev 06/2016
Spirometry Facility Certification Form
Spirometry Results Notification Form
Modified
8500
2833
0
Form
CDC/NIOSH 2.15 (E), rev 04/2015
Spirometry Results Notification form edit
Spirometry Test for Coal Miners
Modified
8500
2125
0
Form
CDC/NIOSH 2.6 (02/2015)
Consent, Release and History Form for Autopsy
Total burden requested under this ICR:
60751
11753
8
To view an IC, click on IC Title