EE-28 (Transportation Authorization Request)

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

Documents and Forms

Document Name Document Type
Form EE-28 EE-28 (Transportation Authorization Request) Form and Instruction
EE-28 Transportation Authorization Request EE-28 Transportation Authorization Request.pdf owcpmed.dol.gov/ Form and Instruction
EE-28 Transportation Authorization Request EE-28 Transportation Authorization Request.pdf owcpmed.dol.gov/ Form and Instruction

Information Collection (IC) Details

IC Title:	EE-28 (Transportation Authorization Request)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 30.404(b) 20 CFR 30.700 20 CFR 30.400(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EE-28	Transportation Authorization Request	EE-28 Transportation 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: 625	Number of Respondents for Small Entity: 94

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	244	2,256
Annual IC Time Burden (Hours)	417	41	376
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.