Coal Miner Radiograph (CWHSP)

National Coal Workers' Health Surveillance Program (CWHSP)

Documents and Forms

Document Name Document Type
Form CDC/NIOSH 2.8(E), Coal Miner Radiograph (CWHSP) Form
CDC/NIOSH 2.8(E), Chest Radiograph Classification Attachment 11 Chest Rad Classification Form Form No. CDC NIOSH (M) 2.8.docx Form
CDC/NIOSH 2.8(E), Chest Radiograph Classification Attachment 11 Chest Rad Classification Form Form No. CDC NIOSH (M) 2.8.docx Form
Attachment 10 .docx Sample Letter (Results of Radiograph) IC Document
Attachment 10 .docx Sample Letter (Results of Radiograph) IC Document

Information Collection (IC) Details

IC Title:	Coal Miner Radiograph (CWHSP)	Agency IC Tracking Number:	0920-0020

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CDC/NIOSH 2.8(E), Revised 01/2020	Chest Radiograph Classification	Attachment 11 Chest Rad Classification Form Form No. CDC NIOSH (M) 2.8.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0153 Mortality Studies in Coal Mining	FR Citation: 51 FR 42478

Number of Respondents: 8,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,500	-6,060	14,560
Annual IC Time Burden (Hours)	2,125	-1,515	3,640
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Sample Letter (Results of Radiograph)	Attachment 10 .docx	12/02/2021

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