Information Collection

Spirometry Test for Coal Miners

IC 197449 under ICR 202507-0920-012 · OMB 0920-0020.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC/NIOSH 2.6 (02/ Consent, Release and History Form for Autopsy Spirometry Test for Coal Miners	Form
Form 0920-24IK Consent Release and History Form Spirometry Test for Coal Miners	Form
CDC/NIOSH 2.6 (02/ Consent, Release and History Form for Autopsy Attachment 19 NCWAS Consent, Release and Hist Form Form No. CDC NIOSH (M) 2.6.docx	Form
0920-24IK Consent Release and History Form Attachment 19_Consent Release and History Form for Autopsy 01 2015_FILLABLE (2.6).pdf	Form
Attachment 18 Sample Letter to Participating Miners_ Spiro Exam Results.docx Sample Letter (Spirometry Examination results)	IC Document
Attachment 18_Sample Spiro Results Notification Letter BLANK.PDF Sample Spiro Results Notification	IC Document

IC Title:

Agency IC Tracking Number:

0920-0020-24IK

Is this a Common Form? No

IC Status: Unchanged

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	CDC/NIOSH 2.6 (02/2015)				Yes	Yes	Fillable Fileable Signable
Form	0920-24IK				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0153 Mortality Studies in Coal Mining

FR Citation: 51 FR 42476

Number of Respondents: 619

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	619	619
Annual IC Time Burden (Hours)	155	155
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Sample Letter (Spirometry Examination results)		02/04/2022
Sample Spiro Results Notification		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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