EEOICPA Dose Reconstruction Introductory Letters & Telephone Interview

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

⚠️ Notice: This information collection may be referencing outdated material.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
EEOICPA Dose Reconstruction Introductory Letters & Telephone Interview Form and Instruction
Phone Interviews and Introductory Letters Attachment C.doc Form and Instruction

Information Collection (IC) Details

IC Title:	EEOICPA Dose Reconstruction Introductory Letters & Telephone Interview	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
Form and Instruction	none	Phone Interviews and Introductory Letters	Attachment C.doc		Yes	Yes	Fillable Fileable

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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,600	-600	4,200
Annual IC Time Burden (Hours)	3,600	-600	4,200
Annual IC Cost Burden (Dollars)	0	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.