Form B 42 CFR Part 83.9

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

OMB: 0920-0639

IC ID: 180183

Information Collection (IC) Details

View Information Collection (IC)

Form B 42 CFR Part 83.9
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Form B Attachment D SEC Form B.docx Yes No Fillable Printable

Income Security Survivor Compensation

09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program   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 -3 0 0 8
Annual IC Time Burden (Hours) 25 0 -15 0 0 40
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment D1 Form B instructions Attachment D1 SEC Form B Instructions.rev 2.pdf 07/14/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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