Coal Contractor Plan CDC/NIOSH 2.18

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⚠️ Notice: This information collection may be referencing outdated material.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 2.18 Coal Contractor Plan CDC/NIOSH 2.18 Form
2.18 Coal Contractor Plan 2.18_Form_CoalContractorPlan012020_updated.docx Form
2.18 Coal Contractor Plan 2.18_Form_CoalContractorPlan012020_updated.docx Form
Attachment 5.docx Sample Letter to Coal Mine Operator or Contractor IC Document
Attachment 5.docx Sample Letter to Coal Mine Operator or Contractor IC Document
2.18_Instructions_CDC_NIOSH_2.18_REV0120_ContractorPlan_Instructions_updated.docx Instructions for 2.18 Form IC Document
2.18_Instructions_CDC_NIOSH_2.18_REV0120_ContractorPlan_Instructions_updated.docx Instructions for 2.18 Form IC Document

Information Collection (IC) Details

IC Title:	Coal Contractor Plan CDC/NIOSH 2.18	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	2.18	Coal Contractor Plan	2.18_Form_CoalContractorPlan012020_updated.docx		Yes	No	Fillable Printable

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: 575	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	Previously Approved
Annual Number of Responses for this IC	575	575
Annual IC Time Burden (Hours)	288	288
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sample Letter to Coal Mine Operator or Contractor	Attachment 5.docx	03/19/2015
Instructions for 2.18 Form	2.18_Instructions_CDC_NIOSH_2.18_REV0120_ContractorPlan_Instructions_updated.docx	04/22/2021

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