Form CDC/NOISH (M) 2.9 CDC/NOISH (M) 2.9 Miner Identification Document

National Coal Workers' Health Surveillance Program (CWHSP)

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-0020 can be found here:

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Attachment 5

Miner Identification Document - CDC/NIOSH (M) 2.9

2 page form (printed front and back)

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	CDC User
File Modified	0000-00-00
File Created	2021-01-27