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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 Individuals or Households
Modified
56057
19476
23207
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
7525
1881
3687
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
2438
1833
1195
Other-EEOICP forms for State Government
Total burden requested under this ICR:
66020
23190
28089
To view an IC, click on IC Title