EE-26 (Rehabilitative Therapies Authorization Request)

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

Documents and Forms

Document Name Document Type
Form EE-26 EE-26 (Rehabilitative Therapies Authorization Request) Form and Instruction
EE-26 Rehabiltative Therapies Authorization Request EE-26 Rehabilitative Therapies Authorization Request.pdf owcpmed.dol.gov/ Form and Instruction
EE-26 Rehabiltative Therapies Authorization Request EE-26 Rehabilitative Therapies Authorization Request.pdf owcpmed.dol.gov/ Form and Instruction

Information Collection (IC) Details

IC Title:	EE-26 (Rehabilitative Therapies Authorization Request)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 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-26	Rehabiltative Therapies Authorization Request	EE-26 Rehabilitative Therapies 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: 1,250	Number of Respondents for Small Entity: 5

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	2,500	2,100	400
Annual IC Time Burden (Hours)	417	350	67
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.