Miner Identification Document (CDC/NIOSH 2.9)

National Coal Workers' Health Surveillance Program (CWHSP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0020 can be found here:

Documents and Forms

Document Name Document Type
Form CDC/NOISH (M) 2.9 Miner Identification Document (CDC/NIOSH 2.9) Form and Instruction
CDC/NOISH (M) 2.9 Miner Identification Document Att 5_Form 2.9_Miner Identification Document.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Miner Identification Document (CDC/NIOSH 2.9)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CDC/NOISH (M) 2.9	Miner Identification Document	Att 5_Form 2.9_Miner Identification Document.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 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.	FR Citation: 72 FR 42414

Number of Respondents: 10,383	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10,383	5,383	5,000
Annual IC Time Burden (Hours)	3,461	1,794	1,667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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