Information Collection Request

Division of Energy Employees Occupational Illnesses Compensation (DEEOIC) Authorization Request Forms

ICR 202208-1240-003 · OMB 1240-0060 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form EE-32 EE-32 (Home Health Care Authorization Request) Form and Instruction Modified Repair queued
Form EE-30 EE-30 (Transplant Authorization Request) Form and Instruction Unchanged Repair queued
Form EE-28 EE-28 (Transportation Authorization Request) Form and Instruction Unchanged Repair queued
Form EE-26 EE-26 (Rehabilitative Therapies Authorization Request) Form and Instruction Unchanged Repair queued
Form EE-24 EE-24 (Durable Medical Equipment Authorization) Form and Instruction Unchanged Repair queued
Form EE-22 EE-22 (General Medical Authorization Request) Form and Instruction Unchanged Missing upstream
EE-32 (Home Health Care Authorization Request) Redlined updates.docx Supplementary Document Uploaded 2022-08-05 Repair queued
Justification - Home Health Care Authorization (EE-32).docx Justification for No Material/Nonsubstantive Change Uploaded 2022-08-05 Missing upstream
Supporting Statement 1240-0NEW (DEEEOIC) 5.26.21 CLEAN.docx Supporting Statement A Uploaded 2021-05-26 Repair queued
1240-0NEW 30-day FRN published.pdf Supplementary Document Uploaded 2021-04-15 Missing upstream
60-day FRN (1240-0NEW (DEEOIC)) published.pdf Supplementary Document Uploaded 2021-01-19 Repair queued
20 CFR Part 30.pdf Supplementary Document Uploaded 2020-09-24 Repair queued
42 USC 7384 et seq.pdf Supplementary Document Uploaded 2020-09-24 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
243779 EE-32 (Home Health Care Authorization Request) Form and Instruction Modified
243778 EE-30 (Transplant Authorization Request) Form and Instruction Unchanged
243777 EE-28 (Transportation Authorization Request) Form and Instruction Unchanged
243776 EE-26 (Rehabilitative Therapies Authorization Request) Form and Instruction Unchanged
243775 EE-24 (Durable Medical Equipment Authorization) Form and Instruction Unchanged
243774 EE-22 (General Medical Authorization Request) Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
05/31/2024 05/31/2024
66,770 66,770
11,129 11,129
0 0





table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 66,770 66,770 0 0 0 0
Annual Time Burden (Hours) 11,129 11,129 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No