Physicians Panel Guidelines

ICR 200206-1910-002

OMB: 1910-5120

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
23446
Migrated
ICR Details
1910-5120 200206-1910-002
Historical Active
DOE/DOEOA
Physicians Panel Guidelines
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/07/2002
Retrieve Notice of Action (NOA) 06/10/2002
  Inventory as of this Action Requested Previously Approved
08/31/2005 08/31/2005
8,000 0 0
8,000 0 0
0 0 0

The information collection is required of DOE contractor employees who apply for DOE assistance in filing a State work- men's compensation

None
None


No

1
IC Title Form No. Form Name
Physicians Panel Guidelines

  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 8,000 0 0 8,000 0 0
Annual Time Burden (Hours) 8,000 0 0 8,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/10/2002


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