Information Collection Request

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

ICR 201306-0920-003 · OMB 0920-0020 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form No 2.8 Roentgenographic Interpretation Form and Instruction Modified Repair queued
Form 5 Coal Workers' Health Surveillance Program (CWHSP)-X-ray Coal Miners Form Modified Available
Form 5 Coal Workers' Health Surveillance Program (CWHSP)-Spirometry Test Form Modified Available
Form 5 Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist Form Modified Repair queued
Form 5 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 Kin (form 2.6) Form Modified Available
Form CDC/NIOSH (M) 2.9 Interpretating Physician Certification Document Form and Instruction Modified Available
Form CDC/NIOSH (M) 2.9 Facility Certification Document Form and Instruction Modified Available
Form CDC/NIOSH (M) 2.9 Coal Mine Operator's Plan Form and Instruction Modified Repair queued
Form CDC/NIOSH (M) 2.9 Miner Identification Document Form and Instruction Modified Repair queued
Request for Nonsubstantive Change 6.3.13.docx Justification for No Material/Nonsubstantive Change Uploaded 2013-06-03 Available

IC Document Collections

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
Roentgenographic Interpretation Form No 2.8 rointgenographic interpretation form
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, 4 Miner Identification Document ,   Coal Mine Operator's Plan ,   Facility Certification Document ,   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
Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kin (form 2.6) 5 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6)
Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist 5, 6 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6) ,   Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist
Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist 5, 6, 9 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6) ,   Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist ,   Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist
Coal Workers' Health Surveillance Program (CWHSP)-Spirometry Test 5, 6, 9, none Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6) ,   Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist ,   Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist ,   Spirometry
Coal Workers' Health Surveillance Program (CWHSP)-X-ray Coal Miners 5, 6, 9 Coal Workers' Health Surveillance Program (CWHSP)-Consent Release and History Form- Next of Kim (form 2.6) ,   Coal Workers' Health Surveillance Program (CWHSP)- Invoice-Pathologist ,   Coal Workers' Health Surveillance Program (CWHSP)- Report Pathologist

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