Coal Mine Operator's Plan (CDC/NOISH (M) 2.10)

National Coal Workers' Health Surveillance Program (CWHSP)

Documents and Forms

Document Name Document Type
Form CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan (CDC/NOISH (M) 2.10) Form
CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan Attachment 3 Coal Mine Operator Form No. CDC NIOSH (M) 2.10.docx Form
CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan Attachment 3 Coal Mine Operator Form No. CDC NIOSH (M) 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
Att 5 Sample Letters Coal Mine Operator or Contractor.docx Sample Letter to the Coal Mine Operator/Contractor IC Document
Att 5 Sample Letters Coal Mine Operator or Contractor.docx Sample Letter to the Coal Mine Operator/Contractor IC Document
Att 9_Sample Letter to Miners Informing Oppur to Participate.docx Att 9 Sample Letters to Miners IC Document
Att 9_Sample Letter to Miners Informing Oppur to Participate.docx Att 9 Sample Letters to Miners IC Document

Information Collection (IC) Details

IC Title:	Coal Mine Operator's Plan (CDC/NOISH (M) 2.10)	Agency IC Tracking Number:	0920-0020

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	CDC/NIOSH (M) 2.10 (E). rev 01/2015	Coal Mine Operator's Plan	Attachment 3 Coal Mine Operator Form No. CDC NIOSH (M) 2.10.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0149-Morbidity Studies in Coal Mining, Metal and Non-Metal Mining and General Industry and 0920-0153- Mortality 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: 0 %

	Approved	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
Sample Letter to the Coal Mine Operator/Contractor	Att 5 Sample Letters Coal Mine Operator or Contractor.docx	01/13/2022
Att 9 Sample Letters to Miners	Att 9_Sample Letter to Miners Informing Oppur to Participate.docx	01/25/2022

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