Information Collection

Authorization for Payment of Autopsy

IC 197448 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⚠️ Notice: This information collection may be referencing outdated material.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 CWHSP 2.19, Dec 20 Authorization for Payment of Autopsy	Form
Form CWHSP 2.19, Dec 20 Authorization for Payment of Autopsy Authorization for Payment of Autopsy	Form
Form 0920-24IK Authorizaion for Payment of Autopsy Authorization for Payment of Autopsy	Form
CWHSP 2.19, Dec 20 Authorization for Payment of Autopsy Attachment 22 Auth for Pay of Autopsy Form No. CDC NIOSH (M) 2.19.pdf	Form
CWHSP 2.19, Dec 20 Authorization for Payment of Autopsy Attachment 22 Auth for Pay of Autopsy Form No. CDC NIOSH (M) 2.19.pdf	Form
0920-24IK Authorizaion for Payment of Autopsy Attachment 22_Authorizaion for Payment of Autopsy Form (2.19).pdf	Form
0920-24IK Authorizaion for Payment of Autopsy Attachment 22_Authorizaion for Payment of Autopsy Form (2.19).pdf	Form
Attachment 21 42 CFR 37.203 Path Report of Autopsy - Sample.docx Pathologist Report of Autopsy -- Sample	IC Document
Attachment 21 42 CFR 37.203 Path Report of Autopsy - Sample.docx Pathologist Report of Autopsy -- Sample	IC Document
Attachment 20 .docx Autopsy Invoice Sample	IC Document
Attachment 20 .docx Autopsy Invoice Sample	IC Document
Attachment 20_NCWAS Autopsy Sample Invoice_42 CFR 37.202.docx NCWAS Autopsy Sample Invoice	IC Document
Attachment 20_NCWAS Autopsy Sample Invoice_42 CFR 37.202.docx NCWAS Autopsy Sample Invoice	IC Document
Attachment 21_NCWAS Path Report of Autopsy_42 CFR 37.203.docx NCWAS Path Report of Autopsy	IC Document
Attachment 21_NCWAS Path Report of Autopsy_42 CFR 37.203.docx NCWAS Path Report of Autopsy	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Authorization for Payment of Autopsy

Agency IC Tracking Number:

0920-0020

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	CWHSP 2.19, Dec 2020				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 Mortality in Coal Miners

FR Citation: 51 FR 42746

Number of Respondents: 4

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Pathologist Report of Autopsy -- Sample		02/04/2022
Autopsy Invoice Sample		11/29/2021
NCWAS Autopsy Sample Invoice		04/02/2025
NCWAS Path Report of Autopsy		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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