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⚠️ Notice: This information collection may be referencing outdated material.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 0920-0020 Miner Identification Document (CDC/NIOSH 2.9) Form
2.9 Miner Identification Document Attachment 8.docx Form
2.9 Miner Identificaiton Document form 2.9 -proposed changes.docx Form
0920-0020 Miner Identification Document Form M 2.9 25MAR2019 Miner Identification Document 2.9_updated2019.docx Form

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	0920-0020	Miner Identification Document Form M 2.9 25MAR2019	Miner Identification Document 2.9_updated2019.docx	NA	Yes	Yes	Fillable Fileable
Form	2.9	Miner Identification Document	Attachment 8.docx		Yes	No	Fillable Printable
Form	2.9	Miner Identificaiton Document	form 2.9 -proposed changes.docx		Yes	Yes	Fillable Printable

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	14,560	14,560
Annual IC Time Burden (Hours)	4,854	4,854
Annual IC Cost Burden (Dollars)	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.