REPORT OF VETILATORY STUDY - CM-907, ROENTGENOGRAPHIC INTERPRETATION - CM-933 & CM-933B, MEDICAL HISTORY & EXAM. FOR COAL MINE WORKERS' PNEUMOCONIOSIS - CM-988, ETC.

ICR 198702-1215-006

OMB: 1215-0090

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
1215-0090 198702-1215-006
Historical Active 198605-1215-007
DOL/ESA
REPORT OF VETILATORY STUDY - CM-907, ROENTGENOGRAPHIC INTERPRETATION - CM-933 & CM-933B, MEDICAL HISTORY & EXAM. FOR COAL MINE WORKERS' PNEUMOCONIOSIS - CM-988, ETC.
Revision of a currently approved collection   No
Regular
Approved without change 04/22/1987
Retrieve Notice of Action (NOA) 02/25/1987
  Inventory as of this Action Requested Previously Approved
01/31/1990 01/31/1990 05/31/1989
38,500 0 38,500
8,341 0 7,700
0 0 0

20 CFR PART 718 SPECIFIES THAT CERTAIN INFORMATION RELATIVE TO THE MEDICAL CONDITION A CLAIMANT WHO IS ALLEGING THE PRESENCE OF PNEUMOCONIOSIS BE OBTAINED AS A ROUTINE FUNCTION OF THE CLAIMS ADJUDICATION PROCESS. THE MEDICAL SPECIFICATIONS IN THE REGULATIONS HAVE BEEN FORMATTED IN A VARIETY OF FORMS TO PROMOTE EFFICIENCY AND ACCURACY IN GATHERING THE REQUIRED DAT THESE FORMS WERE DESIGNED TO MEET THE NEED OF ESTABLISHING MEDICAL

None
None


No

1
IC Title Form No. Form Name
REPORT OF VETILATORY STUDY - CM-907, ROENTGENOGRAPHIC INTERPRETATION - CM-933 & CM-933B, MEDICAL HISTORY & EXAM. FOR COAL MINE WORKERS' PNEUMOCONIOSIS - CM-988, ETC. CM-907, CM-933, CM-933B, CM988, CM1159

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 38,500 38,500 0 0 0 0
Annual Time Burden (Hours) 8,341 7,700 0 641 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/25/1987


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