National Coal Workers' X-ray Surveillance Program (CWXSP) - Federal Mine Safety and Health Act 1977 (42CFR37)

Forms and Documents

Document Name	Status
Form CDC/NIOSH (M) 2.8 Roentgenographic Interpretation Form	Modified
Form CDC/NIOSH (M) 2.9 Interpretating Physician Certification Document Form and Instruction	New
Form CDC/NIOSH (M) 2.9 Facility Certification Document Form and Instruction	New
Form CDC/NIOSH (M) 2.9 Coal Mine Operator's Plan Form and Instruction	New
Form CDC/NIOSH (M) 2.9 Miner Identification Document Form and Instruction	New
Part B NIOSH CWXSP Renewal.doc Supporting Statement B	2007-12-07
ATTACHMENT 10 Stakeholders.doc Supplementary Document	2007-12-07
Attachment 9 60 day FRN published.pdf Supplementary Document	2007-12-07
Attachment 2.pdf Supplementary Document	2007-12-07
Attachment 1.doc Supplementary Document	2007-12-07
LIST OF ATTACHMENTS.doc Supplementary Document	2007-12-07
Part A SS RENEWAL 2007 .doc Supporting Statement A	2008-01-03

IC Document Collections

IC ID	Document Title	Status
6620	Roentgenographic Interpretation Form	Modified
183370	Interpretating Physician Certification Document Form and Instruction	New
183369	Facility Certification Document Form and Instruction	New
183368	Coal Mine Operator's Plan Form and Instruction	New
183367	Miner Identification Document Form and Instruction	New

ICR Details

OMB Control No: 0920-0020	ICR Reference No: 200801-0920-006
Status: Historical Active	Previous ICR Reference No: 200404-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Coal Workers' X-ray Surveillance Program (CWXSP) - Federal Mine Safety and Health Act 1977 (42CFR37)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/25/2008
	Date Received in OIRA: 01/11/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved
Responses	15,525	0	0
Time Burden (Hours)	2,330	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Federal Mine Health and Safety Act of 1977, PL 95-164, (which amended the Federal Coal Mine Health and Safety Act of 1969) (Attachment 1), is intended to protect the health and safety of underground coal miners. This Act provides the basis and mandate for all forms being utilized in conjunction with this data collection for the "National Coal Workers' X-Ray Surveillance Program (CWXSP)."

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Authorizing Statute(s): PL: Pub.L. 95 - 164 111 Name of Law: Federal Mine Safety & Health Act of 1977, Public Law 91-173, as amended by Public Law 95-164
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 42414	08/02/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 70865	12/13/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Roentgenographic Interpretation	CDC/NIOSH (M) 2.8	Roentgenographic Interpretation
Miner Identification Document	CDC/NIOSH (M) 2.9	Miner Identification Document
Coal Mine Operator's Plan	CDC/NIOSH (M) 2.9, CDC/NIOSH (M) 2.10	Miner Identification Document ,   Coal Mine Operator's Plan
Facility Certification Document	CDC/NIOSH (M) 2.9, CDC/NIOSH (M) 2.10, CDC/NIOSH (M) 2.11	Miner Identification Document ,   Coal Mine Operator's Plan ,   Facility Certification Document
Interpretating Physician Certification Document	CDC/NIOSH (M) 2.9, CDC/NIOSH (M) 2.10, CDC/NIOSH (M) 2.11, CDC/NIOSH (M) 2.12	Miner Identification Document ,   Coal Mine Operator's Plan ,   Facility Certification Document ,   Facility Certification Document

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ICR Summary of Burden

	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	15,525	0	0	15,525	0	0
Annual Time Burden (Hours)	2,330	0	0	2,330	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: We are requesting an increase of 1,083 burden hours for this approval period due to the increase in the number of participating miners. The form changes are explained below: Miner Identification Document. Form No. CDC/NIOSH (M) 2.9, Rev. 07/07 Two minor changes have been made to the document as part of this renewal process. First, we have added boxes to indicate exactly which medical screening the miner completed (analog x-ray, digital x-ray, and/or spirometry). This section will be completed by the coordinator during medical screening in the NIOSH Mobile Health Screening Unit. It will aid in the final processing of the medical tests and in determining what medical results the miner is to receive. The second change pertains to the back of the form where the example of USA Mine was given under the Mine Name column. Many miners were answering yes, indicating that the mine where they were employed was indeed a USA Mine. What we need in that column is the name of the mine or the name of the mining company. That has been changed for clarification purposes. Neither of these changes will result in an increase in burden time for completion of the form. Interpreting Physician Certification Document Form No. CDC/NIOSH (M) 2.12, Rev. 07/07 Records information on physician qualifications - (Attachment 7). Several changes have been made to this form. Fields at the bottom that are no longer needed have been removed. When selecting new B Readers for interpreting x-rays in the CWHSP, part of the criteria involves whether the B Reader holds an academic appointment. In the past, this has been ascertained via a telephone call. A section has now been added to the form for this inquiry.

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Annual Cost to Federal Government: $500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/04/2008

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