List of Revisions

Program Name: Radiation Exposure Screening and Education Program

Clearance Number: 0906-0012

Revisions:

In an effort to reduce burden on grantees, the Health Resources and Services Administration is removing the following tables/measures from the previously approved information collection request:

1. Table 6: ELIGIBILITY COUNSELING AND REFERRAL SESSIONS Energy Employment Occupational Illness Compensation Program Act (EEOICPA)

• Number of Encounters (face-to-face)

  • Total Staff Hours

  • Hourly Wage

  • *Total Cost

  • Dollar Amount for Supplies (to include pens, note pads, telephone)

2. Table 7: IMPAIRMENT EXAMS (EEOICPA)

• Number of Medical Exams

  • Total Staff Hours

  • Hourly Wage

  • *Total Cost

  • Dollar Amount for Supplies (to include pens, note pads, posters, brochures/handout materials, mileage local travel)

  • *Grand Total

  • Total Staff Hours

  • Hourly Wage

  • *Total Cost

  • Dollar Amount for Supplies (to include pens, note pads, telephone)

• Energy Employment Occupational Illness Compensation Program Act (EEOICPA) Form Comments

The following measure is new to this information collection request:

1. TELEHEALTH (This section is only applicable to projects utilizing telehealth services)

Question 15
1	2	3	4	5	6
Consultant Site	Patient/Patient-data Site	Distance Between (miles)	Miles Roundtrip ('column 3' X 2)	# Patient Care Sessions	Miles Saved ('column 4' X 'column 5')
			0		0
		Total:	0	0	0