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Physician Application for Certification (CDC/NIOSH 2.12)

IC 183370 under ICR 202507-0920-012 · OMB 0920-0020.

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Physician Application for Certification (CDC/NIOSH 2.12) 0920-0020-24IK
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CDC 2.12 (E), Rev 02/2019 Physician Application for Certification Attachment 12 Physician Application for Cert Form No. CDC NIOSH (M) 2.12.docx Yes No Fillable Printable
Form 0920-24IK Physician Certifcation Document Attachment 12_Physician Certifcation Document.pdf Yes Yes Fillable Fileable

Health Illness Prevention

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.  51 FR 42476

4,788 0
   
Private Sector Businesses or other for-profits
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,788 0 0 0 0 4,788
Annual IC Time Burden (Hours) 240 0 0 0 0 240
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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