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
0920-0020-24IK Chest Radiography Attachment 11_2.08_ChestRadiographClassificationForm.pdf 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 14 Sample Letter B Readers (Recertification Examination)).docx Sample Letter to B Readers inform of the Recertification Examination IC Document
Attachment 13_Sample Letters to Physicians reporting outcomes of B Reader Examinations.pdf Attachment 13_Sample Letters to Physicians reporting outcomes of B Reader Examinations IC Document
Attachment 14_Sample Letter to B Readers to Inform Recertification Exam is Due.pdf Attachment 14_Sample Letter to B Readers to Inform Recertification Exam is Due IC Document

Information Collection (IC) Details

IC Title:	Chest Radiograph Classification - B Reader Physician	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) 2.8 REV 01/2020	Chest Radiograph Classification	Attachment 11 Chest Rad Classification Form Form No. CDC NIOSH (M) 2.8.docx		Yes	Yes	Fillable Fileable
Form	0920-0020-24IK	Chest Radiography	Attachment 11_2.08_ChestRadiographClassificationForm.pdf		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 %

	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	8,990	-8,610	17,600
Annual IC Time Burden (Hours)	450	-430	880
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
Attachment 13_Sample Letters to Physicians reporting outcomes of B Reader Examinations	Attachment 13_Sample Letters to Physicians reporting outcomes of B Reader Examinations.pdf	04/02/2025
Attachment 14_Sample Letter to B Readers to Inform Recertification Exam is Due	Attachment 14_Sample Letter to B Readers to Inform Recertification Exam is Due.pdf	04/02/2025

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