Chest Radiograph Classification (CDC/NIOSH Form 2.8)

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⚠️ Notice: This information collection may be referencing outdated material.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 Chest Radiograph Classification (CDC/NIOSH Form 2.8) Form
2.8 Chest Radiograph Classification Attachment 11 03 11 2015.pdf Form
0920-0020 Chest Radiograph Classification Form M 2.8 25MAR2019 CWHSP-Form 2.8 Chest Radiograph Classification.pdf Form
Attachment 13.docx Sample Letter to Physician IC Document
Attachment 14.docx Sample Letter to B Readers IC Document

Information Collection (IC) Details

IC Title:	Chest Radiograph Classification (CDC/NIOSH Form 2.8)	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	Chest Radiograph Classification Form M 2.8 25MAR2019	CWHSP-Form 2.8 Chest Radiograph Classification.pdf	NA	Yes	Yes	Fillable Fileable
Form	2.8	Chest Radiograph Classification	Attachment 11 03 11 2015.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0001 Certified Interpreting Physicians File	FR Citation: 51 FR 42476

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

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

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Previously Approved
Annual Number of Responses for this IC	30,140	30,140
Annual IC Time Burden (Hours)	1,507	1,507
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sample Letter to Physician	Attachment 13.docx	03/19/2015
Sample Letter to B Readers	Attachment 14.docx	03/19/2015

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