Information Collection

Black Lung Clinics Program Database

IC 6545 under ICR 201906-0915-002 · OMB 0915-0292.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0292 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Black Lung Clinics Program Database Form
1 Performance Measures Performance Measures.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Black Lung Clinics Program Database	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Performance Measures	Performance Measures.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 15

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	150	150
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.