Energy Employees Occupational Illness Compensation Program Act Dose Reconstruction Interviews and Forms (EEOICPA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Phone Interviews and Introductory Letters	Form and Instruction	Modified	Available
Form OCAS-1 Statement by Claimant Closing Record on a NIOSH Dose Reconstruction	Form	Modified	Available
Supporting statement A 1 27 15.docx	Supporting Statement A	Uploaded 2015-02-09	Available
Attachment E.doc	Supplementary Document	Uploaded 2015-01-29	Available
Attachment B.PDF	Supplementary Document	Uploaded 2015-01-29	Available
Attachment A.3.pdf	Supplementary Document	Uploaded 2015-01-29	Available
Attachment A.2.pdf	Supplementary Document	Uploaded 2015-01-29	Available
Attachment A.1.pdf	Supplementary Document	Uploaded 2015-01-29	Available
Supporting statement B 1 27 15.docx	Supporting Statement B	Uploaded 2015-01-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6981	EEOICPA Dose Reconstruction Introductory Letters & Telephone Interview	Form and Instruction	Modified	Phone Interviews and Introductory Letters
188308	EEOICPA Dose Reconstruction Interviews Conclusion Form	Form	Modified	Statement by Claimant Closing Record on a NIOSH Dose Reconstruction

ICR Details

OMB Control No: 0920-0530	ICR Reference No: 201501-0920-026
Status: Historical Active	Previous ICR Reference No: 201201-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Energy Employees Occupational Illness Compensation Program Act Dose Reconstruction Interviews and Forms (EEOICPA)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/10/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/09/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2015
Responses	7,200	0	12,600
Time Burden (Hours)	3,900	0	4,900
Cost Burden (Dollars)	0	0	0

---

Abstract: NIOSH is charged with developing reasonable estimates of the radiation doses incurred occupationally by U.S. nuclear weapons workers with cancer that are covered by the Energy Employees Occupational Illness Compensation Program Act of 2000. These radiation dose reconstructions are completed using methods promulgated by HHS under 42 CFR 82. An essential data source for completing the dose reconstructions is the information collected through structured telephone interviews conducted with claimants, who may be energy employees or surviving family members. In some cases, if necessary, co-workers of the employee are interviewed. These individuals may have unique knowledge of work conditions, radiation protection measures, and monitoring practices that are not available from other sources. At the completion of the dose reconstruction process, claimants review the estimated radiation dose, and signify that they have no more relevant information to offer by submitting a conclusion form (OCAS-1).

---

Authorizing Statute(s): US Code: 42 USC 7384 Name of Law: EEOICPA
   EO: EO 13179 Name/Subject of EO: Providing Compensation to America's Nuclear Weapons Workers
   US Code: 2 USC 82.10 Name of Law: Methods for Dose Reconstruction under EEOICPA
   PL: Pub.L. 106 - 398 3624 Name of Law: Energy Employees Occupational Illness Compensation Program Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0920-ZA00	Final or interim final rulemaking	67 FR 22314	05/02/2002

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 65218	11/03/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 6519	02/05/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
EEOICPA Dose Reconstruction Interviews Conclusion Form	OCAS-1	Statement by Claimant Closing Record on a NIOSH Dose Reconstruction
EEOICPA Dose Reconstruction Introductory Letters & Telephone Interview	none	Phone Interviews and Introductory Letters

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,200	12,600	0	0	-5,400	0
Annual Time Burden (Hours)	3,900	4,900	0	0	-1,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden estimates have been revised downward based on lower rates of claims submissions than estimated by DOL prior to program initiation.

---

Annual Cost to Federal Government: $303,800

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/09/2015

---