Information Collection

Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)

IC 250452 under ICR 202507-1225-002 · OMB 1225-0093.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	Form and Instruction
Form 1 DEEOIC Phone Survey Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	Form and Instruction
1 DEEOIC Phone Survey DEEOIC Claimaint Survey v2.pdf	Form and Instruction
1 DEEOIC Phone Survey DEEOIC Claimaint Survey v2.pdf	Form and Instruction
ICR A11 Section 280 Clearance - DEEOIC Paper Survey Development Letter Oct 2021.docx Justification Document - DEEOIC Survey	IC Document
ICR A11 Section 280 Clearance - DEEOIC Paper Survey Development Letter Oct 2021.docx Justification Document - DEEOIC Survey	IC Document

IC Title:

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	1				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
Justification Document - DEEOIC Survey		11/22/2021

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

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