Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Energy Employees Occupational Illness Compensation Program Act Forms (Various) Modified 92763 41378 22000 Form and Instruction EE-7 Spanish Medical Requirements under the Energy Employees Occupational Illness Compensation Act
Form and Instruction EE-1 Spanish Energy Employees Occupational Illness Compensation Program Act Forms. (Various)
Form and Instruction EE-3 Spanish Employment History for a Claim Under the Energy Employees Occupational Illness Compensation Program Act
Form EE-4 Spanish Employment History Affidavit for a Claim under the Energy Employees Occupational Illness Compensation Program Act
Form and Instruction EE-2 Spanish Claim for Survivor Benefits Under the Energy Employees Occupational Illness Compensation Program Act
Form and Instruction EE-1 English Claims for Benefits Under the Energy Employees Occupational Illness Compensation Program Act
Form and Instruction EE-2 English Claim for Survivor Benefits Under the Energy Employees Occupational Illness Compensation Program Act
Form and Instruction EE-3 English Employment History for a Claim Under the Energy Employees Occupational Illness Compensation Program Act
Form EE-4 English Employment History Affidavit for a Claim Under the Energy Employees Occupational Ilness Compensation Program Act
Form EE-7 English Medical Requirements under the Energy Employees Occupational Illness Compensation Program ACt
Form EE-8 Letter to Claimant
Form EE-9 Letter to Claimant
Form and Instruction EE-20 Letter to Claimant
Form and Instruction EE-10 Claim for Additional Wage-Loss and/or Impairment Under the Energy Employees Occupational Illness Compensation Act
Total burden requested under this ICR: 92763 41378 22000  
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