Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6)

National Coal Workers' Health Surveillance Program (CWHSP)

OMB: 0920-0020

IC ID: 197446

Information Collection (IC) Details

View Information Collection (IC)

Consent Release and History Form- Next of Kin (CDC/NIOSH 2.6)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 2.6 Consent, Release and History Form Attachment 19- Form 2.6.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

4 0
   
Individuals or Households
 
   0 %

  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 4 0 3 0 0 1
Annual IC Time Burden (Hours) 1 0 1 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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