Radiographic Facility Certification (CDC/NIOSH (M) 2.11)

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⚠️ Notice: This information collection may be referencing outdated material.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 2.11 Radiographic Facility Certification (CDC/NIOSH (M) 2.11) Form
2.11 Radiographic Facility Certification Attachment 6.docx Form
Attachment 7 03 11 2015.docx Sample Letter to Radiographic Facility IC Document

Information Collection (IC) Details

IC Title:	Radiographic Facility Certification (CDC/NIOSH (M) 2.11)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	2.11	Radiographic Facility Certification	Attachment 6.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0149-Morbidity 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: 51 FR 42476

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sample Letter to Radiographic Facility	Attachment 7 03 11 2015.docx	03/19/2015

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