OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

REPORT OF VENTILATORY STUDY -- CM-907, ROENTGENOGRAPHIC INTERPRETATION -- CM-933 & CM-933B, MEDICAL HISTORY AND EXAMINATION FOR COAL MINE WORKERS' PNEUMOCONIOSIS -- CM-988

ICR 199212-1215-002 · OMB 1215-0090 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
122135 REPORT OF VENTILATORY STUDY -- CM-907, ROENTGENOGRAPHIC INTERPRETATION -- CM-933 & CM-933B, MEDICAL HISTORY AND EXAMINATION FOR COAL MINE WORKERS' PNEUMOCONIOSIS -- CM-988 Form Migrated
ICR Details
1215-0090 199212-1215-002
Historical Active 198911-1215-001
DOL/ESA
REPORT OF VENTILATORY STUDY -- CM-907, ROENTGENOGRAPHIC INTERPRETATION -- CM-933 & CM-933B, MEDICAL HISTORY AND EXAMINATION FOR COAL MINE WORKERS' PNEUMOCONIOSIS -- CM-988
Revision of a currently approved collection   No
Regular
Approved without change 02/25/1993
Retrieve Notice of Action (NOA) 12/03/1992
  Inventory as of this Action Requested Previously Approved
03/31/1996 03/31/1996 02/28/1993
28,000 0 33,200
6,917 0 8,183
0 0 0
SPECIFIES THAT CERTAIN INFORMATION RELATIVE TO THE MEDICAL CONDITION O A CLAIMANT WHO IS ALLEGING THE PRESENCE OF PNEUMOCONIOSIS BE OBTAINED AS A ROUTINE FUNCTION OF THE CLAIMS ADJUDICATION PROCESS. THE MEDICAL SPECIFICATIONS IN THE REGULATION HAVE BEEN FORMATTED IN A VARIETY OF FORMS TO PROMOTE EFFICIENCY AND ACCURACY IN GATHERING THE REQUIRED DAT
None
None
No
1
IC Title Form No. Form Name
REPORT OF VENTILATORY STUDY -- CM-907, ROENTGENOGRAPHIC INTERPRETATION -- CM-933 & CM-933B, MEDICAL HISTORY AND EXAMINATION FOR COAL MINE WORKERS' PNEUMOCONIOSIS -- CM-988 CM-907, CM-933, CM-933B, CM988, CM1159
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 28,000 33,200 0 0 -5,200 0
Annual Time Burden (Hours) 6,917 8,183 0 0 -1,266 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/03/1992