Information Collection Request

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

ICR 201302-0920-006 · OMB 0920-0020 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form No 2.8 rointgenographic interpretation form Form and Instruction Modified Available
Form 9 Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist Form and Instruction Modified Available
Form 6 Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist Form Modified Repair queued
Form 5 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6) Form Modified Available
Form 9 Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist Form and Instruction Modified Available
Form 6 Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist Form Modified Available
Form 5 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6) Form Modified Available
Form 9 Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist Form and Instruction Modified Available
Form 6 Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist Form Modified Available
Form 5 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6) Form Modified Available
Form 6 Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist Form Modified Available
Form 5 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6) Form Modified Available
Form 5 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6) Form Modified Available
Form CDC/NIOSH (M) 2.12 Facility Certification Document Form and Instruction Modified Repair queued
Form CDC/NIOSH (M) 2.11 Facility Certification Document Form and Instruction Modified Available
Form CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan Form and Instruction Modified Repair queued
Form CDC/NIOSH (M) 2.9 Miner Identification Document Form and Instruction Modified Available
Form 4 Facility Certification Document Form Modified Available
Form CDC/NIOSH (M) 2.11 Facility Certification Document Form and Instruction Modified Available
Form CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan Form and Instruction Modified Repair queued
Form CDC/NIOSH (M) 2.9 Miner Identification Document Form and Instruction Modified Available
Form CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan Form and Instruction Modified Available
Form CDC/NIOSH (M) 2.9 Miner Identification Document Form and Instruction Modified Available
Form CDC/NIOSH (M) 2.9 Miner Identification Document Form and Instruction Modified Available
Request for Nonsubstantive Change 1 11 13.docx Justification for No Material/Nonsubstantive Change Uploaded 2013-01-14 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
6620 Roentgenographic Interpretation Form and Instruction Modifiedrointgenographic interpretation form
197450 Coal Workers' Health Surveillance Program (CWHSP)-X-ray Coal Miners Form and Instruction ModifiedCoal Workers' Health Surveillance Program (CWHSP)- Report Pathologist
197450 Coal Workers' Health Surveillance Program (CWHSP)-X-ray Coal Miners Form ModifiedCoal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
197450 Coal Workers' Health Surveillance Program (CWHSP)-X-ray Coal Miners Form ModifiedCoal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
197449 Coal Workers' Health Surveillance Program (CWHSP)-Spirometry Test Form and Instruction ModifiedCoal Workers' Health Surveillance Program (CWHSP)- Report Pathologist
197449 Coal Workers' Health Surveillance Program (CWHSP)-Spirometry Test Form ModifiedCoal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
197449 Coal Workers' Health Surveillance Program (CWHSP)-Spirometry Test Form ModifiedCoal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
197448 Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist Form and Instruction ModifiedCoal Workers' Health Surveillance Program (CWHSP)- Report Pathologist
197448 Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist Form ModifiedCoal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
197448 Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist Form ModifiedCoal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
197447 Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist Form ModifiedCoal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
197447 Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist Form ModifiedCoal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
197446 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kin (form 2.6) Form ModifiedCoal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
183370 Interpretating Physician Certification Document Form and Instruction ModifiedFacility Certification Document
183370 Interpretating Physician Certification Document Form and Instruction ModifiedFacility Certification Document
183370 Interpretating Physician Certification Document Form and Instruction ModifiedCoal Mine Operator's Plan
183370 Interpretating Physician Certification Document Form and Instruction ModifiedMiner Identification Document
183369 Facility Certification Document Form ModifiedFacility Certification Document
183369 Facility Certification Document Form and Instruction ModifiedFacility Certification Document
183369 Facility Certification Document Form and Instruction ModifiedCoal Mine Operator's Plan
183369 Facility Certification Document Form and Instruction ModifiedMiner Identification Document
183368 Coal Mine Operator's Plan Form and Instruction ModifiedCoal Mine Operator's Plan
183368 Coal Mine Operator's Plan Form and Instruction ModifiedMiner Identification Document
183367 Miner Identification Document Form and Instruction ModifiedMiner Identification Document

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2014 06/30/2014 06/30/2014
23,250 0 23,250
4,471 0 4,471
0 0 0





Reginfo record details
10
table that charts list of burden
IC Title Form No. Form Name
Coal Mine Operator's Plan CDC/NIOSH (M) 2.9, CDC/NIOSH (M) 2.10 ,  
Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist 5, 6 ,  
Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist 5, 6, 9 ,   ,  
Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kin (form 2.6) 5
Coal Workers' Health Surveillance Program (CWHSP)-Spirometry Test 5, 6, 9 ,   ,  
Coal Workers' Health Surveillance Program (CWHSP)-X-ray Coal Miners 6, 9, 5 ,   ,  
Facility Certification Document CDC/NIOSH (M) 2.11, 4, CDC/NIOSH (M) 2.9, CDC/NIOSH (M) 2.10 ,   ,   ,  
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 CDC/NIOSH (M) 2.9
Roentgenographic Interpretation Form No 2.8

table that charts list 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 23,250 23,250 0 0 0 0
Annual Time Burden (Hours) 4,471 4,471 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No