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

ICR 202503-1240-002

OMB: 1240-0060

Federal Form Document

Forms and Documents

Document Name	Status
Form EE-32 EE-32 (Home Health Care Authorization Request) Form and Instruction	Modified
Form EE-32 EE-32 (Home Health Care Authorization Request) Form and Instruction	Modified
Form EE-30 EE-30 (Transplant Authorization Request) Form and Instruction	Unchanged
Form EE-30 EE-30 (Transplant Authorization Request) Form and Instruction	Unchanged
Form EE-28 EE-28 (Transportation Authorization Request) Form and Instruction	Unchanged
Form EE-28 EE-28 (Transportation Authorization Request) Form and Instruction	Unchanged
Form EE-26 EE-26 (Rehabilitative Therapies Authorization Request) Form and Instruction	Unchanged
Form EE-26 EE-26 (Rehabilitative Therapies Authorization Request) Form and Instruction	Unchanged
Form EE-24 EE-24 (Durable Medical Equipment Authorization) Form and Instruction	Unchanged
Form EE-24 EE-24 (Durable Medical Equipment Authorization) Form and Instruction	Unchanged
Form EE-22 EE-22 (General Medical Authorization Request) Form and Instruction	Unchanged
Form EE-22 EE-22 (General Medical Authorization Request) Form and Instruction	Unchanged
Justification - 1240-0060 -n DEEOIC Authorization Forms_Home Health Care Authorization Request (EE-32) ONLY.docx Justification for No Material/Nonsubstantive Change	2025-03-24
Justification - 1240-0060 -n DEEOIC Authorization Forms_Home Health Care Authorization Request (EE-32) ONLY.docx Justification for No Material/Nonsubstantive Change	2025-03-24
Supporting Statement 1240-0060_06 21_2024_FINAL_MN_clean.docx Supporting Statement A	2024-06-21
Supporting Statement 1240-0060_06 21_2024_FINAL_MN_clean.docx Supporting Statement A	2024-06-21
20 CFR Part 30.pdf Supplementary Document	2020-09-24
20 CFR Part 30.pdf Supplementary Document	2020-09-24
42 USC 7384 et seq.pdf Supplementary Document	2020-09-24
42 USC 7384 et seq.pdf Supplementary Document	2020-09-24

IC Document Collections

IC ID	Document Title	Status
243779	EE-32 (Home Health Care Authorization Request) Form and Instruction	Modified
243779	EE-32 (Home Health Care Authorization Request) Form and Instruction	Modified
243778	EE-30 (Transplant Authorization Request) Form and Instruction	Unchanged
243778	EE-30 (Transplant Authorization Request) Form and Instruction	Unchanged
243777	EE-28 (Transportation 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
243776	EE-26 (Rehabilitative Therapies Authorization Request) Form and Instruction	Unchanged
243775	EE-24 (Durable Medical Equipment Authorization) 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
243774	EE-22 (General Medical Authorization Request) Form and Instruction	Unchanged