Spirometry Facility Employee - Notification form 2.16

National Coal Workers' Health Surveillance Program (CWHSP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0020 can be found here:

Documents and Forms

Document Name Document Type
Form 2.16 Spirometry Facility Employee - Notification form 2.16 Form
2.16 Spriometry Notification Attachment 15.docx Form

Information Collection (IC) Details

IC Title:	Spirometry Facility Employee - Notification form 2.16	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2.16	Spriometry Notification	Attachment 15.docx		Yes	No	Fillable Printable

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 – 09-20-0153	FR Citation: 51 FR 42478

Number of Respondents: 10,383	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,383	10,383
Annual IC Time Burden (Hours)	1,731	1,731
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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