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) Modified 2425 412 821
EE -5B - Supplemental Employment Evidence - DOE Contractors Modified 6816 3408 2308
EE 5A - Supplemental Employment Evidence Modified 163 82 55
EEOICP Forms for Individuals or Households Modified 65362 18273 22136 Form and Instruction EE-1 English
Form and Instruction EE-2 English
Form and Instruction EE-3 English
Form Form EE-8
Form EE-9
Form EE-10
Form and Instruction EE-20
Form EE-12
Form EE-16 and EN-16
Form and Instruction EE-17A
Form and Instruction EE-13
Form and Instruction EE-17B
Form and Instruction EE-4 English
Form and Instruction EE-4
Form and Instruction EE-4 Spanish
EEOICP Forms for Private Sector Modified 3500 1750 1185 Form EE-7
Form and Instruction EE-17B
EEOICP Forms for State Governments Modified 51 14 17 Form EE-13
Total burden requested under this ICR: 78317 23939 26522  
To view an IC, click on IC Title