EEOICP Forms for State Governments

Energy Employees Occupational Illness Compensation Program Act Forms

OMB: 1240-0002

IC ID: 178684

Information Collection (IC) Details

View Information Collection (IC)

EEOICP Forms for State Governments
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form EE-13 with EN-13 Letter to State Workers' Compensation EE-13 with EN-13.doc No   Paper Only

Income Security General Retirement and Disability

DOL/OWCP-11  81 FR 25868

51 0
   
State, Local, and Tribal Governments
 
   0 %

  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 51 0 0 0 0 51
Annual IC Time Burden (Hours) 816 0 0 0 0 816
Annual IC Cost Burden (Dollars) 26 0 0 0 0 26

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