Information Collection

Black Lung Clinics Program Database

IC 6545 under ICR 201308-0915-004 · OMB 0915-0292.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0292 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Black Lung Clinics Program Database Form
1 PIMS Measures Black Lung PIMS measures.pdf Form
0292 ATS spirometry.pdf BLCP Spirometry guidelines IC Document
0292 ATS guidelines.pdf BLCP ATS standards IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Black Lung Clinics Program Database	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 55a (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	PIMS Measures	Black Lung PIMS measures.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15	0	15
Annual IC Time Burden (Hours)	150	-150	300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
BLCP Spirometry guidelines	0292 ATS spirometry.pdf	09/06/2007
BLCP ATS standards	0292 ATS guidelines.pdf	09/06/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.