View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) from Claimants with Initial Claims for Home Health Care	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	DEEOIC Home Health Care Survey	Home Health Care Survey.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	4,000	0	0	0	0	4,000
Annual IC Time Burden (Hours)	333	0	0	0	0	333
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Home Health Care Cover Letter	Home Health Care Cover Letter.docx	11/14/2022
ICR A11 Section 280 Clearance - DEEOIC Home Health Care	ICR A11 Section 280 Clearance - DEEOIC Paper Survey HHC November 2022.docx	11/14/2022

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