Information Collection

Facility Certification Document

IC 183369 under ICR 200801-0920-006 · OMB 0920-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0020 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC/NIOSH (M) 2.9 Facility Certification Document	Form and Instruction
CDC/NIOSH (M) 2.9 Miner Identification Document Form 2.9.pdf	Form and Instruction
CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan Form 210.pdf	Form and Instruction
CDC/NIOSH (M) 2.11 Facility Certification Document Form 211.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Facility Certification Document

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CDC/NIOSH (M) 2.9	Miner Identification Document	Form 2.9.pdf	No	No	Paper Only
Form and Instruction	CDC/NIOSH (M) 2.10	Coal Mine Operator's Plan	Form 210.pdf	No	No	Paper Only
Form and Instruction	CDC/NIOSH (M) 2.11	Facility Certification Document	Form 211.pdf	No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 0920-0149-Mortality Studies in Coal Mining, Metal and Non-Metal Mining and General Industry and 0920-0153- Mortality Studies in coal Mining, Metal and Non-Metal Mining and General Industry.

FR Citation: 72 FR 42414

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	25	25
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.