Information Collection

EE-24 (Durable Medical Equipment Authorization)

IC 243775 under ICR 202009-1240-003 · OMB 1240-0060.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0060 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EE-24 EE-24 (Durable Medical Equipment Authorization)	Form and Instruction
EE-24 Durable Medical Equipment Authorization Request EE-24 (Durable Medical Equipment Authorization Request).docx owcpmed.dol.gov/	Form and Instruction
EE-24 Durable Medical Equipment Authorization Request EE-24 (Durable Medical Equipment Authorization Request).docx owcpmed.dol.gov/	Form and Instruction

IC Title:

EE-24 (Durable Medical Equipment Authorization)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 30.400(a) 20 CFR 30.400(c) 20 CFR 30.700

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 and Instruction	EE-24	Durable Medical Equipment Authorization Request	EE-24 (Durable Medical Equipment Authorization Request).docx	https://owcpmed.dol.gov/	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: DOL/OWCP-11

FR Citation: 81 FR 25765

Number of Respondents: 850

Number of Respondents for Small Entity: 43

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,700	1,700
Annual IC Time Burden (Hours)	283	283
Annual IC Cost Burden (Dollars)	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.