Information Collection Request

National Coal Workers' Health Surveillance Program (CWHSP)

ICR 201503-0920-003 · OMB 0920-0020 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 2.8 Chest Radiograph Classification (CDC/NIOSH Form 2.8) Form Modified Repair queued
Form 2.18 Coal Contractor Plan CDC/NIOSH 2.18 Form Modified Available
Form 2.17 Spirometry Technician - Results Form 2.17 Form Removed Repair queued
Form 2.16 Spirometry Facility Employee - Notification form 2.16 Form Removed Repair queued
Form 2.15 Spirometry Results Notification CDC/NIOSH 2.15 Form Modified Repair queued
Form 2.14 Spirometry Facility Supervisor - Certification Document 2.14 Form Modified Repair queued
Form 2.13 Spirometry Facility Employee - Respiratory Assessment 2.13 Form Modified Repair queued
Form 2.6 Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6) Form Modified Repair queued
Form 2.12 Physician Application for Certification (CDC/NIOSH 2.12) Form Modified Available
Form 2.11 Radiographic Facility Certification (CDC/NIOSH (M) 2.11) Form Modified Repair queued
Form 2.10 Coal Mine Operator's Plan (CDC/NOISH (M) 2.10) Form Modified Available
Form 2.9 Miner Identification Document (CDC/NIOSH 2.9) Form Modified Available
Attachment 25.docx Supplementary Document Uploaded 2015-03-18 Repair queued
Attachment 24.docx Supplementary Document Uploaded 2015-03-18 Repair queued
Attachment 23- 60day.pdf Supplementary Document Uploaded 2015-03-18 Available
Attachment 2.docx Supplementary Document Uploaded 2015-03-18 Repair queued
SupSta B.docx Supporting Statement B Uploaded 2015-03-18 Available
SupSta A_ 03 11 2015.docx Supporting Statement A Uploaded 2015-03-18 Repair queued
Attachment 1- revised.docx Supplementary Document Uploaded 2014-07-30 Available
Att 15_42CFR Part 37.docx Supplementary Document Uploaded 2014-03-07 Available
Att 1_Medical Exam excerpt.docx Supplementary Document Uploaded 2014-03-07 Available
ICR Details
0920-0020 201503-0920-003
Historical Active 201406-0920-018
HHS/CDC 21545
National Coal Workers' Health Surveillance Program (CWHSP)
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 06/30/2015
Retrieve Notice of Action (NOA) 03/23/2015
  Inventory as of this Action Requested Previously Approved
06/30/2018 36 Months From Approved 02/28/2015
104,158 0 20,766
20,276 0 3,462
0 0 0

The Coal Workers' Health Surveillance Program (CWHSP) is a congressionally-mandated medical examination program for monitoring the health of underground coal miners, established under the Federal Coal Mine Health and Safety Act of 1969. Through delegation of authority, the Act directs NIOSH to study the causes and consequences of coal-related respiratory disease, and in cooperation with the Mine Safety and Health Administration, to carry out a program for early detection and prevention of coal workers' pneumoconiosis and to provide the opportunity for an autopsy after the death of a coal miner.

PL: Pub.L. 91 - 173 203 Name of Law: Federal Coal Mine Health and Safety Act
   PL: Pub.L. 91 - 596 20 Name of Law: Occupational Safety and Health Act
   US Code: 42 USC 37 Name of Law: Specifications for Medical Exam of Coal Miners
  
None

Not associated with rulemaking

  79 FR 74094 12/15/2014
80 FR 14143 03/18/2015
No

  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 104,158 20,766 0 -20,766 30,180 73,978
Annual Time Burden (Hours) 20,276 3,462 0 -3,462 7,379 12,897
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
This request for reinstatement with changes includes an increase in burden hours due to new estimates of participation based on expanded surveillance activities due to MHSA final rule 30 CFR 70-72, 75, and 90. Burden estimates are subject to rounding in ROCIS.

$2,262,097
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/23/2015