Form A 42 CFR 83.9

EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)

OMB: 0920-0639

IC ID: 7107

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Document Type
Instruction
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Form A 42 CFR 83.9
 
No Modified
 
Voluntary
 
42 CFR 83

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attachment C SEC Form A.pdf Yes Yes Printable Only

Income Security Survivor Compensation

09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program records. HHS/CDC/NIOSH  68 FR 55962

5 0
   
Individuals or Households
 
   10 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5 0 0 -25 0 30
Annual IC Time Burden (Hours) 1 0 0 -1 0 2
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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