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Spirometry Results Notification Form

IC 212090 under ICR 202507-0920-012 · OMB 0920-0020.

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Spirometry Results Notification Form 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/NIOSH 2.15 (E), rev 04/2015 Spirometry Results Notification form edit Attachment 17 Spiro Results Notification Form Form No. CDC NIOSH (M) 2.15.docx NA Yes Yes Fillable Fileable
Form 0920-24IK Spirometry Results Attachment 17 Spirometry-Results-Notification- Form (2.15)_REVISED 02192025.pdf Yes Yes Fillable Fileable

Health Illness Prevention

Mortality Studies in Coal Mining, Metal and Non-Metal Mining and General Industry – 09-20-0153  51 FR 42478

619 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 619 0 0 0 0 619
Annual IC Time Burden (Hours) 206 0 0 0 0 206
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Spirometry Examination Results -- Sample Letter Attachment 18 Sample Letter to Participating Miners_ Spiro Exam Results.docx 02/04/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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