Information Collection

Radiographic Facility Certification (CDC/NIOSH (M) 2.11)

IC 183369 under ICR 202111-0920-021 · OMB 0920-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0020 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 2.11 (E), rev Radiographic Facility Certification (CDC/NIOSH (M) 2.11)	Form
CDC 2.11 (E), rev Radiographic Facility Certification Attachment 6 Radiograph Facility Cert Doc Form No. CDC NIOSH (M) 2.11.docx	Form
CDC 2.11 (E), rev Radiographic Facility Certification Attachment 6 Radiograph Facility Cert Doc Form No. CDC NIOSH (M) 2.11.docx	Form
Att 7_Sample Letter Rad Fac Approval.docx Sample Letter to Radiographic Facility	IC Document
Att 7_Sample Letter Rad Fac Approval.docx Sample Letter to Radiographic Facility	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Radiographic Facility Certification (CDC/NIOSH (M) 2.11)

Agency IC Tracking Number:

0920-0020

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CDC 2.11 (E), rev 02/2015	Radiographic Facility Certification	Attachment 6 Radiograph Facility Cert Doc Form No. CDC NIOSH (M) 2.11.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20	-20	40
Annual IC Time Burden (Hours)	10	-10	20
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Sample Letter to Radiographic Facility	Att 7_Sample Letter Rad Fac Approval.docx	01/13/2022

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