Information Collection

Spirometry Facility Certification Form

IC 212089 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 2.14 (E) Spirometry Facility Certification Form Spirometry Facility Certification Form	Form
Form 0920-24IK Spirometry-Facility-Certification-Form Spirometry Facility Certification Form	Form
CDC/NIOSH 2.14 (E) Spirometry Facility Certification Form Attachment 15 Spiro Facility Cert Doc Form No. CDC NIOSH_(M) 2.14.docx	Form
0920-24IK Spirometry-Facility-Certification-Form Attachment 15_Spirometry-Facility-Certification-Form (2.14).pdf	Form
Attachment 13 Sample Letters to Physicians rept outcomes of B Reader Exam.docx Physician Reporting B Reader Exam Outcomes- Sample Letter	IC Document

IC Title:

Agency IC Tracking Number:

0920-0020-24IK

Is this a Common Form? No

IC Status: Unchanged

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/NIOSH 2.14 (E), rev 06/2016				Yes	Yes	Fillable Fileable
Form	0920-24IK				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Mortality Studies in Coal Mining, Metal and Non-Metal Mining and General Industry â 09-20-0153

FR Citation: 51 FR 42478

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Physician Reporting B Reader Exam Outcomes- Sample Letter		02/04/2022

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].