EE 5A - Supplemental Employment Evidence

Energy Employees Occupational Illness Compensation Program Act Forms

OMB: 1240-0002

IC ID: 251535

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EE 5A - Supplemental Employment Evidence
 
No New
 
Voluntary
 
20 CFR 30.112

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Income Security General Retirement and Disability

DOL/OWCP-11  81 FR 25868

773 0
   
Individuals or Households
 
   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 773 0 0 773 0 0
Annual IC Time Burden (Hours) 387 0 0 387 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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