Spirometry Results Notification CDC/NIOSH 2.15

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⚠️ Notice: This information collection may be referencing outdated material.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 2.15 Spirometry Results Notification CDC/NIOSH 2.15 Form
2.15 Spirometry Results Notification form edit Attachment 17 Spiro Results Notification Form 2.15 tim0.docx Form

Information Collection (IC) Details

IC Title:	Spirometry Results Notification CDC/NIOSH 2.15	Agency IC Tracking Number:	16ABJ

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	2.15	Spirometry Results Notification form edit	Attachment 17 Spiro Results Notification Form 2.15 tim0.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Mortality Studies in Coal Mining, Metal and Non-Metal Mining and General Industry – 09-20-0153	FR Citation: 51 FR 42478

Number of Respondents: 14,560	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	14,560	0	14,560
Annual IC Time Burden (Hours)	4,854	1	4,853
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.