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Federal forms, ICRs, and supporting documents

Information Collection

Physician Application for Certification (CDC/NIOSH (M) 2.12)

IC 183370 under ICR 201403-0920-010 · OMB 0920-0020.

Documents and Forms
Document Name
Document Type
Form
Form
Information Collection (IC) Details

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Physician Application for Certification (CDC/NIOSH (M) 2.12)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CDC/NIOSH (M) 2.12 Physical Application for Certification Att 7_Form 2.12_Physician Application for Certification.docx No No Paper Only

Health Illness Prevention

0920-0149-Mortality Studies in Coal Mining, Metal and Non-Metal Mining and General Industry and 0920-0153- Mortality Studies in coal Mining, Metal and Non-Metal Mining and General Industry.  72 FR 42414

100 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100 0 -200 0 0 300
Annual IC Time Burden (Hours) 17 0 -33 0 0 50
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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