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
Coal Contractor Plan 2.18 New 383 192 0 Form 2.18
Coal Mine Operator's Plan (CDC/NOISH (M) 2.10) Modified 575 288 0 Form and Instruction 2.10
Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6) Modified 5 1 0 Form CDC/NIOSH 2.6
Facility Certification Document (CDC/NIOSH (M) 2.11) Modified 40 20 0 Form CDC/NOISH (M) 2.11
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
Physician Application for Certification (CDC/NIOSH (M) 2.12) Modified 50 8 0 Form CDC/NIOSH (M) 2.12
Report Pathologist (CWHSP) Modified 5 0 0 Instruction
Spirometry Facility Employee - Notification form 2.16 New 10383 1731 0 Form 2.16
Spirometry Facility Employee - Respiratory Assessment 2.13 New 10383 865 0 Form 2.13
Spirometry Facility Supervisor - Certification Document 2.14 New 200 100 0 Form 2.14
Spirometry Technician - Pre-test Checklist 2.15 New 10383 865 0 Form 2.15
Spirometry Technician - Results Form 2.17 New 10383 1731 0 Form 2.17
Spirometry Test for Coal Miners Modified 10383 3461 0 Instruction
X-ray Coal Miners (CWHSP) Modified 10383 2596 0 Form 5
Form 6
Form and Instruction 9
Total burden requested under this ICR: 94744 16359 0  
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