EEOICPA Dose Reconstruction Interviews and Form

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
EEOICPA Dose Reconstruction Interviews and Form Form and Instruction
Telephone Interview with Claimants and Coworkers Phone Interview with Revisions 12.09.doc Form and Instruction
Phone Interview with Proposed Revisions.doc Proposed changes to interview forms IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EEOICPA Dose Reconstruction Interviews and Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Telephone Interview with Claimants and Coworkers	Phone Interview with Revisions 12.09.doc		No	No	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: 4,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,200	4,200
Annual IC Time Burden (Hours)	4,200	4,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Proposed changes to interview forms	Phone Interview with Proposed Revisions.doc	01/07/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.