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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
EEOICP Forms for Business or other for profits
Modified
7704
1973
0
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 Federal Government
Modified
51
816
0
Other-EEOICP forms for State Government
EEOICP Forms for Individuals or Households
Modified
29211
14688
2317
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
Total burden requested under this ICR:
36966
17477
2317
To view an IC, click on IC Title