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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.