EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 83.9 EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)	Form	New	Available
Supptg Statmt Part A.doc	Supporting Statement A	Uploaded 2007-05-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7107	EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)	Instruction	Modified
180186	EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)	Instruction	New
180185	EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)	Instruction	New
180184	EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)	Instruction	New
180183	EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)	Form	New

ICR Details

OMB Control No: 0920-0639	ICR Reference No: 200705-0920-006
Status: Historical Active	Previous ICR Reference No: 200402-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: 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: 07/06/2007
	Date Received in OIRA: 05/16/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2010	36 Months From Approved	06/30/2007
Responses	100	0	90
Time Burden (Hours)	235	0	54
Cost Burden (Dollars)	0	0	0

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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. Among other duties, the executive order directed HHS to establish and implement procedures for considering petitions by classes of nuclear weapons workers to be added to the "Special Exposure Cohort" (the "Cohort"), a cohort of various groups of workers selected by Congress 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. In brief, EEOICPA authorizes HHS to designate such classes of employees for addition to the Cohort when HHS lacks sufficient information to estimate with sufficient accuracy the radiation doses of the employees.

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Authorizing Statute(s): US Code: 42 USC 7834-7835 Name of Law: Employees Occupational Ilness Compensation Program Act
   PL: Pub.L. 42 - 83 1 Name of Law: Procedures for Designating
   EO: EO 13179 Name/Subject of EO: Providing Compensation to America's Nuclear Weapons Workers
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 10217	03/07/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 25315	05/04/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)
EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)	83.9	Special Exposure Cohort Petition Form B
EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)
EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)
EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)

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ICR Summary of Burden

table that charts list 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	100	90	0	10	0	0
Annual Time Burden (Hours)	235	54	0	181	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The only change to this package is an increase to the burden hours because more petitioners are requesting to have their work site named as a special exposure cohort.

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Annual Cost to Federal Government: $17,934

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 05/16/2007

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