Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
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
EEOICP Forms for Individuals or Households Modified 56057 19476 23207 Form EE_10 and EN-10 Letter to Claimant
Form and Instruction EE-20 and EN-20 Letter to Claimant
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 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-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-3 English Employment History for a Claim Under The Energy Employees Occupational Illness Compensation Program Act
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-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-4 English Employment History Affidavit for a Claim Under the Energy Employees Occupational Illness Compensation Program Act
Form EE-9 and EN-9 Letter to Claimant
Form Form EE-8 and EN-8 Letter to Claimant
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
Total burden requested under this ICR: 66020 23190 28089  
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