Information Collection

EEOICPA Dose Reconstruction Interviews Conclusion Form

IC 188308 under ICR 202502-0920-003 · OMB 0920-0530.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OCAS-1 EEOICPA Dose Reconstruction Interviews Conclusion Form	Form
Form OCAS-1 Statement by Claimant Closing Record on a NIOSH Dose Reconstruction EEOICPA Dose Reconstruction Interviews Conclusion Form	Form
Form 0920-0530 Attachment D_OCAS-1 EEOICPA Dose Reconstruction Interviews Conclusion Form	Form
OCAS-1 Statement by Claimant Closing Record on a NIOSH Dose Rec Attachment D.doc	Form
OCAS-1 Statement by Claimant Closing Record on a NIOSH Dose Rec Attachment D.doc	Form
0920-0530 Attachment D_OCAS-1 Attachment D_OCAS-1.docx	Form
0920-0530 Attachment D_OCAS-1 Attachment D_OCAS-1.docx	Form

IC Title:

Agency IC Tracking Number:

0920-0530

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OCAS-1				Yes	No	Fillable Printable
Form	0920-0530				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: 09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program Records

FR Citation: 76 FR 34706

Number of Respondents: 3,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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