Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Authorization Form on behalf of Claimant under 42 CFR 83.7 Unchanged 3 0 1 Form and Instruction n/a Authorization for Individual or Entity to Petition HHS on Behalf of a Class of Energy Employees for Addition to the Special Exposure Cohort
Form A: Special Exposure Cohort Petition 42 CFR 83.9 Unchanged 2 0 1 Form and Instruction n/a Special Exposure Cohort Petition - Form A
Form B: Special Exposure Cohort Petition 42 CFR Part 83.9 Unchanged 5 25 181 Form and Instruction n/a Special Exposure Cohort Petition-Form B
Petitioner Appealing Final Decision under 42 CFR 83.18 Unchanged 2 10 73 Other-Example Request for Review
Petitioner Submission Format other than Form B 42 CFR 83.9 Unchanged 1 6 44 Instruction
Other-Example of Petition without Form B
Total burden requested under this ICR: 13 41 300  
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