Information Collection

Radiographic Facility Certification (CDC/NIOSH (M) 2.11)

IC 183369 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⚠️ Notice: This information collection may be referencing outdated material.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 2.11 (E), rev Radiographic Facility Certification (CDC/NIOSH (M) 2.11)	Form
Form CDC 2.11 (E), rev Radiographic Facility Certification Radiographic Facility Certification (CDC/NIOSH (M) 2.11)	Form
Form 0920-24IK Radiographic Facility Certification Form Radiographic Facility Certification (CDC/NIOSH (M) 2.11)	Form
CDC 2.11 (E), rev Radiographic Facility Certification Attachment 6 Radiograph Facility Cert Doc Form No. CDC NIOSH (M) 2.11.docx	Form
CDC 2.11 (E), rev Radiographic Facility Certification Attachment 6 Radiograph Facility Cert Doc Form No. CDC NIOSH (M) 2.11.docx	Form
0920-24IK Radiographic Facility Certification Form Attachment 6_2.11_RadiographicFacilityCertificationForm.pdf	Form
0920-24IK Radiographic Facility Certification Form Attachment 6_2.11_RadiographicFacilityCertificationForm.pdf	Form
Att 7_Sample Letter Rad Fac Approval.docx Sample Letter to Radiographic Facility	IC Document
Att 7_Sample Letter Rad Fac Approval.docx Sample Letter to Radiographic Facility	IC Document
Attachment 7_ Sample Letter to the radiographic facility to inform that the facility's unit is approved.docx Sample Letter to the radiographic facility	IC Document
Attachment 7_ Sample Letter to the radiographic facility to inform that the facility's unit is approved.docx Sample Letter to the radiographic facility	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Radiographic Facility Certification (CDC/NIOSH (M) 2.11)

Agency IC Tracking Number:

0920-0020

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 2.11 (E), rev 02/2015				Yes	Yes	Fillable Fileable
Form	0920-24IK				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: 14

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

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	14	-6	20
Annual IC Time Burden (Hours)	7	-3	10
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Sample Letter to Radiographic Facility		01/13/2022
Sample Letter to the radiographic facility		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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