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Roentgenographic Interpretation (CM-933), Roentgenographic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report of....

IC 13765 under ICR 200802-1215-002 · OMB 1215-0090.

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Information Collection (IC) Details

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Roentgenographic Interpretation (CM-933), Roentgenographic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report of....
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 718.102-105

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-988 Medical History and Examination for Coal Mine Workers' Pneumoconiosis cm-988.pdf http://www.dol.gov/esa/regs/compliance/owcp/cm-988.pdf Yes No Fillable Printable
Form CM-2907 Report of Ventilatory Study cm-2907.pdf http://www.dol.gov/esa/regs/compliance/owcp/cm-2907.pdf Yes No Fillable Printable
Form CM-933 Roentgenographic Interpretation CM-933 Rev June 2008.pdf http://www.dol.gov/esa/regs/compliance/owcp/cm-933.pdf Yes No Fillable Printable
Form CM-1159 Report of Arterial Blood Gas Study CM-1159 June 2008.doc Yes No Fillable Printable
Form CM-933B Roentgenographic Quality Rereading CM-933 Rev June 2008.pdf http://www.dol.gov/esa/regs/compliance/owcp/cm-933b.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

DOL/ESA-6, DOL/ESA-30  67 FR 16869

17,500 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 17,500 0 0 0 0 17,500
Annual IC Time Burden (Hours) 4,259 0 0 0 0 4,259
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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