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⚠️ Notice: This information collection may be referencing outdated material.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