View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

EEOICP Forms for Individuals or Households
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 30.103 20 CFR 30.206 20 CFR 30.102 20 CFR 30.111 20 CFR 30.417 20 CFR 30.505 20 CFR 30.620 20 CFR 30.207 20 CFR 30.806 20 CFR 30.212 20 CFR 30.221 20 CFR 30.113 20 CFR 30.100 20 CFR 30.114 20 CFR 30.213 20 CFR 30.231 20 CFR 30.415 20 CFR 30.416 20 CFR 30.214 20 CFR 30.222 20 CFR 30.101 20 CFR 30.215 20 CFR 30.226 20 CFR 30.232 20 CFR 30.807 20 CFR 30.905 20 CFR 30.907 20 CFR 30.403

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction EE-1 English http://www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm Yes Yes Fillable Fileable Signable
Form and Instruction EE-2 English http://www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm Yes Yes Fillable Fileable Signable
Form and Instruction EE-3 English http://www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm Yes Yes Fillable Fileable Signable
Form and Instruction EE-4 English http://www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm Yes Yes Fillable Fileable Signable
Form Form EE-8 and EN-8 No   Paper Only
Form EE-9 and EN-9 No   Paper Only
Form EE-10 and EN-10 No   Paper Only
Form and Instruction EE-20 and EN-20 No   Paper Only
Form and Instruction EE-1 Spanish http://www.dol.gov/owcp/energy/regs/complaince/claimsforms.htm Yes Yes Fillable Fileable Signable
Form and Instruction EE-2 Spanish http://www.dol.gov/owcp/energy/regs/complaince/claimsforms.htm Yes Yes Fillable Fileable Signable
Form and Instruction EE-3 Spanish http://www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm Yes Yes Fillable Fileable Signable
Form and Instruction EE-4 Spanish http://www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm Yes Yes Paper Only
Form EE-11A and EN-11A No   Paper Only
Form EE-11B and EN-11B No   Paper Only
Form EE-12 and EN-12 No   Paper Only
Form EE-16 and EN-16 No   Paper Only
Form and Instruction EE-17B Yes No Fillable Fileable
Form EE-17A Yes No Fillable Printable

Income Security General Retirement and Disability

DOL/ESA 49  67 FR 16891

55,167 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 60,751 0 4,694 0 0 56,057
Annual IC Time Burden (Hours) 21,299 0 1,823 0 0 19,476
Annual IC Cost Burden (Dollars) 28,427 0 5,220 0 0 23,207

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