Information Collection

Periodic Medical Surveillance Examinations for Coal Miners

IC 209661 under ICR 201406-1219-003 · OMB 1219-0152.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0152 can be found here:

Documents and Forms

Document Name Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Periodic Medical Surveillance Examinations for Coal Miners	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 72.100(d) 30 CFR 72.100(e)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,223	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,468	-3,928,460	3,929,928
Annual IC Time Burden (Hours)	1,142	-175,179	176,321
Annual IC Cost Burden (Dollars)	441	-53,518	53,959

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.