EEOICPA Dose Reconstruction Interviews and Form

ICR 200510-0920-003

OMB: 0920-0530

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
6981 Migrated
ICR Details
0920-0530 200510-0920-003
Historical Active 200205-0920-001
HHS/CDC
EEOICPA Dose Reconstruction Interviews and Form
Revision of a currently approved collection   No
Regular
Approved without change 01/03/2006
Retrieve Notice of Action (NOA) 10/26/2005
  Inventory as of this Action Requested Previously Approved
01/31/2009 01/31/2009 01/31/2006
12,600 0 15,000
4,900 0 16,250
0 0 0

NIOSH is estimating the radiation doses incurred occupationally by US nuclear weapons production employees with cancer covered by the "Energy Employees Occupational Illness Compensation Act Program Act of 2000". These 'dose reconstructions' will be conducted using methods promulgated by HHS under 42 CFR 82. An essential data source for conducting the dose reconstructions is the claimant or next of kin or coworker of the employee. These individuals have uniquely accessible knowledge of work conditions and radiation protection and exposure measurement practices.

None
None


No

1
IC Title Form No. Form Name
EEOICPA Dose Reconstruction Interviews and Form OCAS-1

  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 12,600 15,000 0 -2,400 0 0
Annual Time Burden (Hours) 4,900 16,250 0 -11,350 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
10/26/2005


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