Information Collection

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

IC 183368 under ICR 202501-0920-010 · OMB 0920-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0020 can be found here:

2025-07-17 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan (CDC/NOISH (M) 2.10)	Form
Form CDC/NIOSH (M) 2.10 Coal Mine Operator's Plan Coal Mine Operator's Plan (CDC/NOISH (M) 2.10)	Form
Form 0920-0020-24IK Operators Plan 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
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
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
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 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
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 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
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

View Information Collection (IC)

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:

table that charts list of 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				Yes	No	Fillable Printable
Form	0920-0020-24IK				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for Form 2.10		04/22/2021
Sample Letter to the Coal Mine Operator/Contractor		01/13/2022
Att 9 Sample Letters to Miners		01/25/2022
Roster Letter to Miners		04/02/2025
Sample letters to Coal ine Operators or Contractor		04/02/2025

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

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