EEOICPA Dose Reconstruction Interviews Conclusion Form

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⚠️ Notice: This information collection may be referencing outdated material.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
Att D_OCAS-1 Form.doc Other-Word

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Word			Att D_OCAS-1 Form.doc		Yes	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: 8,400	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	8,400	8,400
Annual IC Time Burden (Hours)	700	700
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.