EEOICP Forms for Private Sector

Energy Employees Occupational Illness Compensation Program Act Forms

⚠️ Notice: This information collection may be referencing outdated material.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 English EEOICP Forms for Private Sector Form and Instruction
EE-7 English Medial Requirements under rhe Energy Employees Occupatio EE-7 (draft for 2013 clearance).docx Form and Instruction
EE-7 Spanish Requisitos medicos segun la Ley del Programa de Indemniz EE-7-Spa (draft for 2013 clearance).docx Form and Instruction

Information Collection (IC) Details

IC Title:	EEOICP Forms for Private Sector	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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

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 English	Medial Requirements under rhe Energy Employees Occupational Illness Compensation Program Act	EE-7 (draft for 2013 clearance).docx		No		Paper Only
Form and Instruction	EE-7 Spanish	Requisitos medicos segun la Ley del Programa de Indemnizacion por Enfermedades Ocupacionales para Empleados del Sector de la Energia	EE-7-Spa (draft for 2013 clearance).docx		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: 7,525	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	Previously Approved
Annual Number of Responses for this IC	7,525	-179	7,704
Annual IC Time Burden (Hours)	1,881	-92	1,973
Annual IC Cost Burden (Dollars)	3,687	3,687	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.