Attachment 26

National Coal Workers' Health Surveillance Program (CWHSP)

Attachment 26

OMB: 0920-0020

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Attachment 26

Coal Mine – Spirometry (Mock Form)






























































Form Approved

OMB NO: 0920-0020

Exp. Date: xx/xx/20xx















Coal Mine – Spirometry























Public reporting burden of this collection of information is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/Information Collection Review Office, 1600 Clifton Road, NE, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-0020).



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMarsh, Carol E. (CDC/OPHPR/OD)
File Modified0000-00-00
File Created2022-01-11

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