Physician Application for Certification (CDC/NIOSH 2.12)

National Coal Workers' Health Surveillance Program (CWHSP)

OMB: 0920-0020

IC ID: 183370

Information Collection (IC) Details

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Physician Application for Certification (CDC/NIOSH 2.12)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2.12 Physician Application for Certification Attachment 12- Form 2.12.docx Yes Yes Fillable Fileable

Workforce Management Worker Safety

Morbidity Studies in Coal Mining, Metal and Non-metal Mining and General Industry  51 FR 42476

220 0
   
Private Sector Businesses or other for-profits
 
   50 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 220 0 140 0 0 80
Annual IC Time Burden (Hours) 37 0 24 0 0 13
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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