Report of Ventilator Study (CM-907), Roentgenograhic Interpretation (CM-933) Roentgenographic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine.......

ICR 200203-1215-001

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 200203-1215-001
Historical Active 200201-1215-001
DOL/ESA
Report of Ventilator Study (CM-907), Roentgenograhic Interpretation (CM-933) Roentgenographic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine.......
Revision of a currently approved collection   No
Regular
Approved without change 04/02/2002
Retrieve Notice of Action (NOA) 03/29/2002
  Inventory as of this Action Requested Previously Approved
07/31/2005 07/31/2005 05/31/2002
26,000 0 37,800
6,334 0 9,338
0 0 0

20 CFR 718 specifies that certain information relative to the medical condition of a claimant who is alleging the presence of pneumoconiosis be obtained as a routine function of the claim adjuciationprocess. The medical specification in the regulations have been formatted in a variety of forms to promote efficiency and accuracy in gathering the required data. These forms were designed to meet the need to establish medical evidence.

None
None


No

1
IC Title Form No. Form Name
Report of Ventilator Study (CM-907), Roentgenograhic Interpretation (CM-933) Roentgenographic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine....... CM-907, CM-933, CM-933B, CM-988, CM-1159, CM-2907

  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 26,000 37,800 0 -1,481 -10,319 0
Annual Time Burden (Hours) 6,334 9,338 0 -377 -2,627 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
03/29/2002


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