Information Collection

Authorization for Payment of Autopsy

IC 197448 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⚠️ Notice: This information collection may be referencing outdated material.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 CWHSP 2.19, Dec 20 Authorization for Payment of Autopsy	Form
CWHSP 2.19, Dec 20 Authorization for Payment of Autopsy Attachment 22 Auth for Pay of Autopsy Form No. CDC NIOSH (M) 2.19.pdf	Form
CWHSP 2.19, Dec 20 Authorization for Payment of Autopsy Attachment 22 Auth for Pay of Autopsy Form No. CDC NIOSH (M) 2.19.pdf	Form
Attachment 21 42 CFR 37.203 Path Report of Autopsy - Sample.docx Pathologist Report of Autopsy -- Sample	IC Document
Attachment 21 42 CFR 37.203 Path Report of Autopsy - Sample.docx Pathologist Report of Autopsy -- Sample	IC Document
Attachment 20 .docx Autopsy Invoice Sample	IC Document
Attachment 20 .docx Autopsy Invoice Sample	IC Document

IC Title:

Authorization for Payment of Autopsy

Agency IC Tracking Number:

0920-0020

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	CWHSP 2.19, Dec 2020	Authorization for Payment of Autopsy	Attachment 22 Auth for Pay of Autopsy Form No. CDC NIOSH (M) 2.19.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0149 Mortality in Coal Miners

FR Citation: 51 FR 42746

Number of Respondents: 4

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4	3	1
Annual IC Time Burden (Hours)	1	1	0
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Pathologist Report of Autopsy -- Sample	Attachment 21 42 CFR 37.203 Path Report of Autopsy - Sample.docx	02/04/2022
Autopsy Invoice Sample	Attachment 20 .docx	11/29/2021

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