Information Collection

EEOICPA Dose Reconstruction Interviews Conclusion Form

IC 188308 under ICR 201002-0920-002 · OMB 0920-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0530 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No number EEOICPA Dose Reconstruction Interviews Conclusion Form	Form
No number EEOICPA Conclusion Form Attachment D OCAS-1.doc	Form

IC Title:

EEOICPA Dose Reconstruction Interviews Conclusion Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	No number	EEOICPA Conclusion Form	Attachment D OCAS-1.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program Records

FR Citation: 68 FR 55962

Number of Respondents: 8,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	8,400	8,400
Annual IC Time Burden (Hours)	700	700
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.