Information Collection Request

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

ICR 201403-0920-010 · OMB 0920-0020 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CDC/NOISH (M) 2.8 Chest Radiograph Classification (CDC/NIOSH Form 2.8) Form Modified Available
Form 5 X-ray Coal Miners (CWHSP) Form Modified Available
Form CDC/NIOSH 2.6 Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6) Form Modified Repair queued
Form CDC/NIOSH (M) 2.12 Physician Application for Certification (CDC/NIOSH (M) 2.12) Form Modified Available
Form CDC/NOISH (M) 2.11 Facility Certification Document (CDC/NIOSH (M) 2.11) Form Modified Available
Form CDC/NOISH (M) 2.10 Coal Mine Operator's Plan (CDC/NOISH (M) 2.10) Form and Instruction Modified Available
Form CDC/NOISH (M) 2.9 Miner Identification Document (CDC/NIOSH 2.9) Form and Instruction Modified Available
SupSta B_0920-0020.docx Supporting Statement B Uploaded 2014-03-10 Available
Att 15_42CFR Part 37.docx Supplementary Document Uploaded 2014-03-07 Available
Att 14_Contact Information.docx Supplementary Document Uploaded 2014-03-07 Available
Att 13_IRB.docx Supplementary Document Uploaded 2014-03-07 Available
Att 2_60d published FRN.pdf Supplementary Document Uploaded 2014-03-07 Available
Att 1_Medical Exam excerpt.docx Supplementary Document Uploaded 2014-03-07 Available
SupSta A_0920-0020.doc Supporting Statement A Uploaded 2014-03-10 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
6620 Chest Radiograph Classification (CDC/NIOSH Form 2.8) Form Modified
197450 X-ray Coal Miners (CWHSP) Form Modified
197449 Spirometry Test for Coal Miners Instruction Modified
197448 Report Pathologist (CWHSP) Instruction Modified
197447 Invoice-Pathologist (CWHSP) Instruction Modified
197446 Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6) Form Modified
183370 Physician Application for Certification (CDC/NIOSH (M) 2.12) Form Modified
183369 Facility Certification Document (CDC/NIOSH (M) 2.11) Form Modified
183368 Coal Mine Operator's Plan (CDC/NOISH (M) 2.10) Form and Instruction Modified
183367 Miner Identification Document (CDC/NIOSH 2.9) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2017 36 Months From Approved 06/30/2014
22,915 0 23,250
4,418 0 4,471
0 0 0





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 22,915 23,250 0 -335 0 0
Annual Time Burden (Hours) 4,418 4,471 0 -53 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No