Chest Radiograph Classification - B Reader Physician

National Coal Workers' Health Surveillance Program (CWHSP)

Documents and Forms

Document Name Document Type
Form CDC/NIOSH (M) 2.8 Chest Radiograph Classification - B Reader Physician Form
CDC/NIOSH (M) 2.8 Chest Radiograph Classification Attachment 11 Chest Rad Classification Form Form No. CDC NIOSH (M) 2.8.docx Form
CDC/NIOSH (M) 2.8 Chest Radiograph Classification Attachment 11 Chest Rad Classification Form Form No. CDC NIOSH (M) 2.8.docx Form
Attachment 13 Sample Letters to Physicians rept outcomes of B Reader Exam.docx Sample Letter to Physician Reporting Outcome of the B Reader Examination IC Document
Attachment 13 Sample Letters to Physicians rept outcomes of B Reader Exam.docx Sample Letter to Physician Reporting Outcome of the B Reader Examination IC Document
Attachment 14 Sample Letter B Readers (Recertification Examination)).docx Sample Letter to B Readers inform of the Recertification Examination IC Document
Attachment 14 Sample Letter B Readers (Recertification Examination)).docx Sample Letter to B Readers inform of the Recertification Examination IC Document

Information Collection (IC) Details

IC Title:	Chest Radiograph Classification - B Reader Physician	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 (M) 2.8 REV 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: 09-20-0001 Certified Interpreting Physicians File	FR Citation: 51 FR 42476

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	17,600	-12,540	30,140
Annual IC Time Burden (Hours)	880	-627	1,507
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Sample Letter to Physician Reporting Outcome of the B Reader Examination	Attachment 13 Sample Letters to Physicians rept outcomes of B Reader Exam.docx	02/04/2022
Sample Letter to B Readers inform of the Recertification Examination	Attachment 14 Sample Letter B Readers (Recertification Examination)).docx	02/04/2022

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