Coal Mine Operator's Plan (CDC/NOISH (M) 2.10)

National Coal Workers' Health Surveillance Program (CWHSP)

Documents and Forms

Document Name Document Type
Form CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan (CDC/NOISH (M) 2.10) Form
CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan Attachment 3 Coal Mine Operator Form No. CDC NIOSH (M) 2.10.docx Form
0920-0020-24IK Operators Plan Attachment 3_2.10_CoalMineOperatorsPlan.pdf Form
2.10_Instructions_CDC_NIOSH_2.10_REV0120_MinePlan_Instructions_updated.docx Instructions for Form 2.10 IC Document
Att 5 Sample Letters Coal Mine Operator or Contractor.docx Sample Letter to the Coal Mine Operator/Contractor IC Document
Att 9_Sample Letter to Miners Informing Oppur to Participate.docx Att 9 Sample Letters to Miners IC Document
Attachment 9_P01 Roster Letter to Miners.docx Roster Letter to Miners IC Document
Attachment 5_Sample letters to Coal ine Operators or Contractor.docx Sample letters to Coal ine Operators or Contractor IC Document

Information Collection (IC) Details

IC Title:	Coal Mine Operator's Plan (CDC/NOISH (M) 2.10)	Agency IC Tracking Number:	0920-0020-24IK

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) 2.10 (E). rev 01/2015	Coal Mine Operator's Plan	Attachment 3 Coal Mine Operator Form No. CDC NIOSH (M) 2.10.docx		Yes	No	Fillable Printable
Form	0920-0020-24IK	Operators Plan	Attachment 3_2.10_CoalMineOperatorsPlan.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0149-Morbidity Studies in Coal Mining, Metal and Non-Metal Mining and General Industry and 0920-0153- Mortality Studies in coal Mining, Metal and Non-Metal Mining and General Industry.	FR Citation: 51 FR 42476

Number of Respondents: 268	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	268	48	220
Annual IC Time Burden (Hours)	134	24	110
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions for Form 2.10	2.10_Instructions_CDC_NIOSH_2.10_REV0120_MinePlan_Instructions_updated.docx	04/22/2021
Sample Letter to the Coal Mine Operator/Contractor	Att 5 Sample Letters Coal Mine Operator or Contractor.docx	01/13/2022
Att 9 Sample Letters to Miners	Att 9_Sample Letter to Miners Informing Oppur to Participate.docx	01/25/2022
Roster Letter to Miners	Attachment 9_P01 Roster Letter to Miners.docx	04/02/2025
Sample letters to Coal ine Operators or Contractor	Attachment 5_Sample letters to Coal ine Operators or Contractor.docx	04/02/2025

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