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Spirometry Facility Employee - Respiratory Assessment 2.13
National Coal Workers' Health Surveillance Program (CWHSP)
OMB: 0920-0020
IC ID: 212086
OMB.report
HHS/CDC
OMB 0920-0020
ICR 201903-0920-009
IC 212086
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0020 can be found here:
2022-02-07 - Revision of a currently approved collection
2021-09-09 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 2.13
Spirometry Facility Employee - Respiratory Assessment 2.13
Form
2.13 Respiratory Assessment
Attachment 16.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Spirometry Facility Employee - Respiratory Assessment 2.13
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
2.13
Respiratory Assessment
Attachment 16.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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:
14,560
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
14,560
0
0
0
0
14,560
Annual IC Time Burden (Hours)
1,214
0
0
0
0
1,214
Annual IC Cost Burden (Dollars)
0
0
0
0
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.