Coal Mine Operator's Plan (CDC/NIOSH 2.10)

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⚠️ Notice: This information collection may be referencing outdated material.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 2.10 Coal Mine Operator's Plan (CDC/NIOSH 2.10) Form
2.10 Coal mine operator form Attachment 3 Coal Mine Operator Form 2.10.docx Form
2.10 Coal mine operator form Attachment 3 Coal Mine Operator Form 2.10.docx Form
2.10_Instructions_CDC_NIOSH_2.10_REV0120_MinePlan_Instructions_updated.docx Instructions for Form 2.10 IC Document
2.10_Instructions_CDC_NIOSH_2.10_REV0120_MinePlan_Instructions_updated.docx Instructions for Form 2.10 IC Document

Information Collection (IC) Details

IC Title:	Coal Mine Operator's Plan (CDC/NIOSH 2.10)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2.10	Coal mine operator form	Attachment 3 Coal Mine Operator Form 2.10.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: Morbidity Studies in Coal Mining, Metal and Non-metal Mining and General Industry	FR Citation: 51 FR 42476

Number of Respondents: 220	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	220	-168	388
Annual IC Time Burden (Hours)	110	-84	194
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions for Form 2.10	2.10_Instructions_CDC_NIOSH_2.10_REV0120_MinePlan_Instructions_updated.docx	04/22/2021

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