Information Collection

OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives

IC 264003 under ICR 202504-1225-002 · OMB 1225-0093.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0093 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives	Form and Instruction
Authorized Representative Survey OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives	Form and Instruction
Authorized Representative Survey Authorized Representative Survey 12-13-23.pdf	Form and Instruction
Authorized Representative Survey Authorized Representative Survey 12-13-23.pdf	Form and Instruction
ICR _A11 Section 280 Clearance - DEEOIC Authorized Rep December 2023.docx Authorized Representative Survey Supporting Statement	IC Document
ICR _A11 Section 280 Clearance - DEEOIC Authorized Rep December 2023.docx Authorized Representative Survey Supporting Statement	IC Document

IC Title:

OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives

Agency IC Tracking Number:

IC Status: Unchanged

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 and Instruction	N/A				No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorized Representative Survey Supporting Statement		12/19/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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