Information Collection

EEOICP Forms for Business or other for profits

IC 178683 under ICR 200702-1215-010 · OMB 1215-0197.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EE-7 Department of Energy's Response to Employment History for Claim Under the Energy Employees Occupational Illness Compensation Program Act EEOICP Forms for Business or other for profits	Form and Instruction
Form EE-7 Spanish Department of Energy's Response to Employment History for Claim Under the Energy Employees Occupational Illness Compensation Program Act EEOICP Forms for Business or other for profits	Form and Instruction
EE-7 Department of Energy's Response to Employment History fo EE-7 1215-0197 (2007 clearnace).rtf	Form and Instruction
EE-7 Spanish Department of Energy's Response to Employment History fo EE-7 Spanish 1215-0197 (2007 clearance).pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

EEOICP Forms for Business or other for profits

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EE-7				No		Printable Only
Form and Instruction	EE-7 Spanish				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: 20,662

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	20,662	20,662
Annual IC Time Burden (Hours)	5,291	5,291
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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