Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
EE - 7A - Report of Occupational Illness (Part B)/Report of Covered Illness (Part E) New 277 69 0
EE -5B - Supplemental Employment Evidence - DOE Contractors New 2448 1224 0
EE 5A - Supplemental Employment Evidence New 773 387 0
EEOICP Forms for Individuals or Households Modified 38023 11626 30799 Form and Instruction EE-1 English
Form and Instruction EE-2 English
Form and Instruction EE-3 English
Form Form EE-8 and EN-8
Form EE-9 and EN-9
Form EE_10 and EN-10
Form and Instruction EE-20 and EN-20
Form and Instruction EE-1 Spanish
Form and Instruction EE-2 Spanish
Form and Instruction EE-3 Spanish
Form EE-11A and EN-11A
Form EE-11B and EN-11B
Form EE-12 and EN-12
Form EE-16 and EN-16
Form and Instruction EE-17A
Form and Instruction EE-4-Spa
Form and Instruction EE-4
EEOICP Forms for Private Sector Modified 6479 2252 5248 Form EE-7-Spa
Form EE-7
Form and Instruction EE-17B
EEOICP Forms for State Governments Modified 51 816 41 Form EE-13 with EN-13
Total burden requested under this ICR: 48051 16374 36088  
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