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Radiologic Interpretation (CM-933), Radiologic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report of....

IC 13765 under ICR 202401-1240-006 · OMB 1240-0023.

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Information Collection (IC) Details

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Radiologic Interpretation (CM-933), Radiologic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report of....
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 718.202 20 CFR 725.406 20 CFR 718.204 20 CFR 718.102-105

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-933 Radiologic Interpretation CM-933-Form Non-Sub.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-933b Radiologic Quality Rereading CM-933b Non-Sub.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-988 Medical History and Examination for Coal Mine Workers’ Pneumoconiosis CM-988 Non-Sub.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-1159 Report of Arterial Blood Gas Study CM-1159 Non-Sub.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-2907 Report of Ventilatory Study CM-2907 Non-Sub.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable

Income Security General Retirement and Disability

DOL/OWCP-2 and DOL/OWCP-9  67 FR 16869

21,500 0
   
Private Sector Businesses or other for-profits
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 21,500 0 0 0 0 21,500
Annual IC Time Burden (Hours) 5,232 0 0 0 0 5,232
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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