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Form CDC/NIOSH 2.6 CDC/NIOSH 2.6 Consent, Release and History Form
National Coal Workers' X-ray Surveillance Program (CWXSP) - Federal Mine Safety and Health Act 1977 (42CFR37)
Att 9_Form 2.6_Consent Release and History Form
Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6)
OMB: 0920-0020
OMB.report
HHS/CDC
OMB 0920-0020
ICR 201403-0920-010
IC 197446
Form CDC/NIOSH 2.6 CDC/NIOSH 2.6 Consent, Release and History Form
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-0020 can be found here:
2022-02-07 - Revision of a currently approved collection
2021-09-09 - Extension without change of a currently approved collection
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Attachment 9
Consent, Release and History Form No. CDC/NIOSH (M) 2.6
File Type
application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author
CDC User
File Modified
0000-00-00
File Created
2021-01-27
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