Chest Radiograph Classification (CDC/NIOSH Form 2.8)

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⚠️ Notice: This information collection may be referencing outdated material.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 2.8 Chest Radiograph Classification (CDC/NIOSH Form 2.8) Form
2.8 Chest Radiograph Classification Attachment 11 03 11 2015.pdf Form
2.8 Chest Radiograph Classification Attachment 11 03 11 2015.pdf Form
0920-0020 Chest Radiograph Classification Form M 2.8 25MAR2019 CWHSP-Form 2.8 Chest Radiograph Classification.pdf Form
0920-0020 Chest Radiograph Classification Form M 2.8 25MAR2019 CWHSP-Form 2.8 Chest Radiograph Classification.pdf Form
Attachment 13.docx Sample Letter to Physician IC Document
Attachment 13.docx Sample Letter to Physician IC Document
Attachment 14.docx Sample Letter to B Readers IC Document
Attachment 14.docx Sample Letter to B Readers IC Document

Information Collection (IC) Details

IC Title:	Chest Radiograph Classification (CDC/NIOSH Form 2.8)	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	2.8	Chest Radiograph Classification	Attachment 11 03 11 2015.pdf		Yes	Yes	Fillable Fileable
Form	0920-0020	Chest Radiograph Classification Form M 2.8 25MAR2019	CWHSP-Form 2.8 Chest Radiograph Classification.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0001 Certified Interpreting Physicians File	FR Citation: 51 FR 42476

Number of Respondents: 10	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Previously Approved
Annual Number of Responses for this IC	30,140	30,140
Annual IC Time Burden (Hours)	1,507	1,507
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sample Letter to Physician	Attachment 13.docx	03/19/2015
Sample Letter to B Readers	Attachment 14.docx	03/19/2015

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