Information Collection

National Coal Workers' Autopsy Study (42 CFR 37.204)

IC 46042 under ICR 200611-0920-003 · OMB 0920-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0021 can be found here:

Documents and Forms

Document Name Document Type
Form none assigned National Coal Workers' Autopsy Study (42 CFR 37.204) Form
none assigned Consent, History, and Release Form 0021 NCWAS Attachment C Consent Release History Form.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Coal Workers' Autopsy Study (42 CFR 37.204)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 37.204

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none assigned	Consent, History, and Release Form	0021 NCWAS Attachment C Consent Release History Form.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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