View Information Collection (IC)

View Information Collection (IC)

Radiologic Interpretation (CM-933), Radiologic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report of....
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 718.102-105 20 CFR 725.406 20 CFR 718.202 20 CFR 718.204

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CM-933 Radiologic Interpretation 20200430 CM-933.docx http://www.dol.gov/owcp/regs/compliance/cm-933.pdf Yes Yes Fillable Printable
Form and Instruction CM-933b Radiologic Quality Rereading 20200430 CM-933b.docx http://www.dol.gov/owcp/regs/compliance/cm-933b.pdf Yes Yes Fillable Printable
Form and Instruction CM-1159 Report of Arterial Blood Gas Test 20200430 CM-1159.docx http://wwwldol.gov/owcp/regs/compliance/cm-1159.pdf Yes Yes Fillable Printable
Form and Instruction CM-2907 Report of Ventilatory Study 20200430 CM-2907.docx http://www.dol.gov/owcp/regs/compliance/cm-2907.pdf Yes Yes Fillable Printable
Form and Instruction CM-988 Medical History and Examination for Coal Mine Workers Pneumoconiosis 1240-0023 Medical History and Examination for Coal Mine Workers Pneumoconiosis (CM-988).pdf http://www.dol.gov/owcp/regs/compliance/cm-988cm-988a.pdf Yes Yes Fillable Printable

Income Security General Retirement and Disability

DOL/OWCP-2 and DOL/OWCP-9  67 FR 16869

30,000 0
   
Private Sector Businesses or other for-profits
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30,000 0 0 2,500 0 27,500
Annual IC Time Burden (Hours) 7,300 0 0 607 0 6,693
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.