View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0639
ICR Reference No:
202511-0920-001
Status:
Active
Previous ICR Reference No:
202211-0920-005
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-0639
Title:
[NIOSH] EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/09/2026
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/08/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2029
36 Months From Approved
01/31/2026
Responses
13
0
13
Time Burden (Hours)
41
0
41
Cost Burden (Dollars)
300
0
300
Abstract:
The Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 U.S.C. 7384-7385 [1994, supp. 2001], established a compensation program to provide a lump sum payment of $150,000 and medical benefits as compensation to covered employees suffering from designated illnesses incurred as a result of their exposure to radiation, beryllium, or silica while in the performance of duty for the Department of Energy and certain of its vendors, contractors and subcontractors. NIOSH is charged with carrying out certain responsibilities under the Energy Employees Occupational Illness Compensation Program Act of 2000 on behalf of U.S. nuclear weapons workers with cancer. One of these responsibilities is to consider petitions by classes of nuclear weapons workers to be added to the Special Exposure Cohort (SEC), a cohort of workers whose claims for cancer under EEOICPA can be adjudicated without demonstrating that their cancer was “at least as likely as not” caused by radiation doses they incurred in the performance of duty. EEOICPA authorizes HHS to designate such classes of employees for addition to the Cohort when HHS lacks information to estimate the radiation doses received by these workers with sufficient accuracy. This Extension will serve to allow this information collection to continue for an additional three years.
Authorizing Statute(s):
EO: EO 13179 Name/Subject of EO: Providing Compensation to America's Nuclear Weapons Workers
PL:
Pub.L. 42 - 83 1
Name of Law: Procedures for Designating
US Code:
42 USC 7834
Name of Law: Employees Occupational Ilness Compensation Program Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
90 FR 35528
07/28/2025
30-day Notice:
Federal Register Citation:
Citation Date:
90 FR 56156
12/05/2025
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
Authorization Form on behalf of Claimant under 42 CFR 83.7
n/a, 0920-0639
Authorization for Individual or Entity to Petition HHS on Behalf of a Class of Energy Employees for Addition to the Special Exposure Cohort
,
Special Exposure Cohort Petitioner Authorization Form_DEC2025
Form A: Special Exposure Cohort Petition 42 CFR 83.9
n/a, 0920-0639
Special Exposure Cohort Petition - Form A
,
Special Exposure Cohort Petition — Form A_DEC2025
Form B: Special Exposure Cohort Petition 42 CFR Part 83.9
n/a, 0920-0639
Special Exposure Cohort Petition-Form B
,
Special Exposure Cohort Petition — Form B_DEC2025
Petitioner Appealing Final Decision under 42 CFR 83.18
Petitioner Submission Format other than Form B 42 CFR 83.9
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
13
13
0
0
0
0
Annual Time Burden (Hours)
41
41
0
0
0
0
Annual Cost Burden (Dollars)
300
300
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$11,627
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Jeffrey Zirger 404 639-7118 wtj5@cdc.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
12/08/2025
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