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) 0920-0020
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CDC/NIOSH 2.6 (02/2015) Consent, Release and History Form for Autopsy Att 19_NCWAS Consent, Release and Hist Form Form No. CDC NIOSH (M) 2.6.docx Yes No Fillable Fileable Signable

Health Immunization Management

09-20-0153 Mortality Studies in Coal Mining  51 FR 4247

4 0
   
Individuals or Households
 
   0 %

  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 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

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