Information Collection

Periodic Medical Surveillance Examinations for Coal Miners

IC 209661 under ICR 202512-1219-004 · OMB 1219-0152.

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IC Title:

Periodic Medical Surveillance Examinations for Coal Miners

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 72.100(d) 30 CFR 72.100(e)

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

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 634

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	761	-36	797
Annual IC Time Burden (Hours)	296	-14	310
Annual IC Cost Burden (Dollars)	228	-11	239

Documents for IC

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

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