Information Collection

EEOICPA Dose Reconstruction Interviews Conclusion Form

IC 188308 under ICR 201501-0920-026 · OMB 0920-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0530 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OCAS-1 EEOICPA Dose Reconstruction Interviews Conclusion Form	Form
OCAS-1 Statement by Claimant Closing Record on a NIOSH Dose Rec Attachment D.doc	Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OCAS-1	Statement by Claimant Closing Record on a NIOSH Dose Reconstruction	Attachment D.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: 09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program Records

FR Citation: 76 FR 34706

Number of Respondents: 3,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,600	-4,800	8,400
Annual IC Time Burden (Hours)	300	-400	700
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.