View Information Collection (IC)

View Information Collection (IC)

IC Title:	EEOICP Forms for Private Sector	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 30.215 20 CFR 30.222 20 CFR 30.415 through 30.417 20 CFR 30.907 20 CFR 30.207 20 CFR 30.905 20 CFR 30.232 (a) and (b) 20 CFR 30.103 20 CFR 30.106

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EE-7 English	Medial Requirements under rhe Energy Employees Occupational Illness Compensation Program Act	EE-7 (draft for 2013 clearance).docx		No		Paper Only
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	EE-7-Spa (draft for 2013 clearance).docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/ESA-49	FR Citation: 67 FR 16891

Number of Respondents: 7,525	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	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	7,525	0	0	-179	0	7,704
Annual IC Time Burden (Hours)	1,881	0	0	-92	0	1,973
Annual IC Cost Burden (Dollars)	3,687	0	0	3,687	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.