Authorization for Payment of Autopsy

National Coal Workers' Health Surveillance Program (CWHSP)

OMB: 0920-0020

IC ID: 197448

Information Collection (IC) Details

View Information Collection (IC)

Authorization for Payment of Autopsy 0920-0020
 
No Modified
 
Voluntary
 

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

Health Illness Prevention

09-20-0149 Mortality in Coal Miners  51 FR 42746

4 0
   
Private Sector Businesses or other for-profits
 
   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

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.

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