Information Collection

EE-26 (Rehabilitative Therapies Authorization Request)

IC 243776 under ICR 202503-1240-002 · OMB 1240-0060.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0060 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EE-26 EE-26 (Rehabilitative Therapies Authorization Request)	Form and Instruction
Form EE-26 Rehabiltative Therapies Authorization Request 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

IC Title:

EE-26 (Rehabilitative Therapies Authorization Request)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

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

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 and Instruction	EE-26			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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	417	417
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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