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

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

OMB: 0920-0639

IC ID: 7107

Documents and Forms
Document Name
Document Type
Instruction
Information Collection (IC) Details

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EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)
 
No Modified
 
Voluntary
 
42 CFR 83

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Form A secforma.pdf Yes Yes Printable Only

Health Illness Prevention

 

30 0
   
Individuals or Households
 
   10 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30 0 -60 0 0 90
Annual IC Time Burden (Hours) 2 0 -52 0 0 54
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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