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Federal forms, ICRs, and supporting documents

Information Collection Request

Report of Ventilatory Study -- CM-907, Roentgenographic Interpretation -- CM-933 & CM-933b, Medical History & Examination for Coal Mine Workers' Compensation -- CM-988 & Report of....

ICR 199903-1215-001 · 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
13762 Report of Ventilatory Study -- CM-907, Roentgenographic Interpretation -- CM-933 & CM-933b, Medical History & Examination for Coal Mine Workers' Compensation -- CM-988 & Report of.... Form Migrated
ICR Details
1215-0090 199903-1215-001
Historical Active 199601-1215-001
DOL/ESA
Report of Ventilatory Study -- CM-907, Roentgenographic Interpretation -- CM-933 & CM-933b, Medical History & Examination for Coal Mine Workers' Compensation -- CM-988 & Report of....
Extension without change of a currently approved collection   No
Regular
Approved without change 05/24/1999
Retrieve Notice of Action (NOA) 03/19/1999
Approved consistent with clarification in DOL memo of 5-3-99.
  Inventory as of this Action Requested Previously Approved
05/31/2002 05/31/2002 05/31/1999
37,800 0 37,800
9,338 0 9,338
0 0 0
20 CFR 718 specifies that certain information relative to the medical condition of a claimant who is alleging the presence of pneumoconiosis be obtained as a routine function of the claim adjudication process. The medical specifications in the regulations have been formatted in a variety of forms to promote efficiency and accuracy in gathering the required data. These forms were designed to meet the need to establish medical evidence.
None
None
No
  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 37,800 37,800 0 0 0 0
Annual Time Burden (Hours) 9,338 9,338 0 0 0 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.
03/19/1999