EEOICP Forms for Business or other for profits

Energy Employees Occupational Illness Compensation Program Act Forms (Various)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0002 can be found here:

Documents and Forms

Document Name Document Type
Form EE-7 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

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EE-7	Department of Energy's Response to Employment History for Claim Under the Energy Employees Occupational Illness Compensation Program Act	EE-7 1215-0197 (2007 clearnace).rtf		No		Printable Only
Form and Instruction	EE-7 Spanish	Department of Energy's Response to Employment History for Claim Under the Energy Employees Occupational Illness Compensation Program Act	EE-7 Spanish 1215-0197 (2007 clearance).pdf		No		Paper Only

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 %

	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

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.