Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
EEOICP Forms for Individuals or Households Modified 54505 18206 24742 Form and Instruction EE-1 English Worker's Claim for Benefits Under the Energy Employees Occupational Illness Compensation Program Act
Form and Instruction EE-2 English Survivor's Claim for 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 and Instruction EE-4 English Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act
Form Form EE-8 and EN-8 Letter to Claimant
Form EE-9 and EN-9 Letter to Claimant
Form EE_10 and EN-10 Letter to Claimant
Form and Instruction EE-20 and EN-20 Letter to Claimant
Form and Instruction EE-1 Spanish Reclamacion de beneficios segun la Ley del Programa de Indemnizaciom por Enfermedades Ocupacionales para Empleados del Sector de la Energia
Form and Instruction EE-2 Spanish Reclaamacion de beneficios de sobreviviente segun las Ley del Programa de Indemnizacion por Enfermedades Ocupacionales para Empleados del Sector de las Energia
Form and Instruction EE-3 Spanish Historial de empleo para reclamacion segun la Ley del Programa de Indemnizacion por Enfermedades Ocupscionales para Empleados del Sector de la Energia
Form and Instruction EE-4 Spanish Declaracion jurada sobre historial de empleo para reclamacion sequin la Ley del Programa de Indemnizacioon por Enfermedades Ocupacionales para Empleados del Sector de la Energia
Form EE-11A and EN-11A Letter to Claimant
Form EE-11B and EN-11B Letter to Claimant
Form EE-12 and EN-12 Letter to Claimant
Form EE-16 and EN-16 Letter to Claimant
EEOICP Forms for Private Sector Modified 6065 1517 3032 Form and Instruction EE-7 English Medial Requirements under rhe Energy Employees Occupational Illness Compensation Program Act
Form and Instruction EE-7 Spanish Requisitos medicos segun la Ley del Programa de Indemnizacion por Enfermedades Ocupacionales para Empleados del Sector de la Energia
EEOICP Forms for State Governments Modified 51 816 26 Form EE-13 with EN-13 Letter to State Workers' Compensation
Total burden requested under this ICR: 60621 20539 27800  
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