Information Collection

Periodic Medical Surveillance Examinations for Coal Miners

IC 209661 under ICR 202303-1219-006 · OMB 1219-0152.

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Information Collection (IC) Details

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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(e) 30 CFR 72.100(d)

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: 664	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	797	-555	1,352
Annual IC Time Burden (Hours)	310	-739	1,049
Annual IC Cost Burden (Dollars)	239	-167	406

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