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

View Information Collection (IC)

Physician Application for Certification (CDC/NIOSH 2.12) 0920-0020
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CDC 2.12 (E), Rev 02/2019 Physician Application for Certification Attachment 12 Physician Application for Cert Form No. CDC NIOSH (M) 2.12.docx Yes No Fillable Printable

Health Illness Prevention

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.  51 FR 42476

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

  Approved 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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