Coal Contractor Plan CDC/NIOSH 2.18

National Coal Workers' Health Surveillance Program (CWHSP)

Documents and Forms

Document Name Document Type
Form CDC/NIOSH (M) 2.18 Coal Contractor Plan CDC/NIOSH 2.18 Form
CDC/NIOSH (M) 2.18 Coal Contractor Plan Attachment 4 Coal Contractor Plan Form No. CDC NIOSH (M) 2.18.docx Form
0920-24IK Contractor Plan Attachment 4_2.18_CoalContractorPlan.pdf Form
Attachment 5 Sample Letters Coal Mine Operator or Contractor.docx Coal Mine Operator or Contractor -- Sample Letter IC Document
2.18_Instructions_CDC_NIOSH_2.18_REV0120_ContractorPlan_Instructions_updated.docx Instructions for 2.18 Form IC Document
Attachment 5_Sample letters to Coal ine Operators or Contractor.docx Sample Letter IC Document

Information Collection (IC) Details

IC Title:	Coal Contractor Plan CDC/NIOSH 2.18	Agency IC Tracking Number:	0920-0020-24IK

Is this a Common Form? No		IC Status: Modified

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	CDC/NIOSH (M) 2.18 (E), rev 01/2015	Coal Contractor Plan	Attachment 4 Coal Contractor Plan Form No. CDC NIOSH (M) 2.18.docx		Yes	No	Fillable Printable
Form	0920-24IK	Contractor Plan	Attachment 4_2.18_CoalContractorPlan.pdf		Yes	Yes	Fillable Fileable

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: 68	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	68	-92	160
Annual IC Time Burden (Hours)	34	-46	80
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Coal Mine Operator or Contractor -- Sample Letter	Attachment 5 Sample Letters Coal Mine Operator or Contractor.docx	02/04/2022
Instructions for 2.18 Form	2.18_Instructions_CDC_NIOSH_2.18_REV0120_ContractorPlan_Instructions_updated.docx	04/22/2021
Sample Letter	Attachment 5_Sample letters to Coal ine Operators or Contractor.docx	04/02/2025

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