Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Coal Miner Radiograph (CWHSP) Modified 4788 1197 0 Form CDC/NIOSH 2.8(E), Revised 01/2020
Form 0920-24IK
Authorization for Payment of Autopsy Modified 4 1 0 Form CWHSP 2.19, Dec 2020
Form 0920-24IK
B Reader for Physician New 1 18 0 Form 0920-24IK
Chest Radiograph Classification - B Reader Physician Modified 8990 450 0 Form CDC/NIOSH (M) 2.8 REV 01/2020
Form 0920-0020-24IK
Coal Contractor Plan CDC/NIOSH 2.18 Modified 68 34 0 Form CDC/NIOSH (M) 2.18 (E), rev 01/2015
Form 0920-24IK
Coal Mine Operator's Plan (CDC/NOISH (M) 2.10) Modified 268 134 0 Form CDC/NIOSH (M) 2.10 (E). rev 01/2015
Form 0920-0020-24IK
Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6) Modified 4 1 0 Form CDC/NIOSH 2.6 (02/2015)
Form and Instruction 0920-24IK
Invoice-Pathologist Modified 4 1 0 Form and Instruction CWHSP 2.19, Dec 2020
Form 0920-24IK
Miner Identification Document (CDC/NIOSH 2.9) Modified 4345 1448 0 Form CDC/NIOSH 2.9(E), Revised 02/2019
Form 0920-0020-24IK
Pathologist Report Modified 4 1 0 Form CWHSP 2.19, 12/2020
Form 0920-24IK
Physician Application for Certification (CDC/NIOSH 2.12) Modified 4788 240 0 Form CDC 2.12 (E), Rev 02/2019
Form 0920-24IK
Radiographic Facility Certification (CDC/NIOSH (M) 2.11) Modified 14 7 0 Form CDC 2.11 (E), rev 02/2015
Form 0920-24IK
Request for Medical Records New 779 65 0 Form 0920-24IK
Respiratory Assessment Form - Spirometry Facility Employee Modified 619 52 0 Form CDC/NIOSH 2.13 (E), rev 04/2016
Form 0920-24IK
Spirometry Facility Certification Form Modified 15 8 0 Form CDC/NIOSH 2.14 (E), rev 06/2016
Form 0920-24IK
Spirometry Results Notification Form Modified 619 206 0 Form CDC/NIOSH 2.15 (E), rev 04/2015
Form 0920-24IK
Spirometry Test for Coal Miners Modified 619 155 0 Form CDC/NIOSH 2.6 (02/2015)
Form 0920-24IK
Total burden requested under this ICR: 25929 4018 0  
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