EE-24 (Durable Medical Equipment Authorization)

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

Documents and Forms

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.pdf owcpmed.dol.gov/ Form and Instruction
EE-24 Durable Medical Equipment Authorization Request EE-24 Durable Medical Equipment Authorization Request.pdf owcpmed.dol.gov/ Form and Instruction

Information Collection (IC) Details

IC Title:	EE-24 (Durable Medical Equipment Authorization)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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

Information Collection 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.pdf	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: 3,333	Number of Respondents for Small Entity: 43

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20,000	18,300	1,700
Annual IC Time Burden (Hours)	3,333	3,050	283
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.