Information Collection

OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) from Claimants with Initial Claims for Home Health Care

IC 256742 under ICR 202507-1225-002 · OMB 1225-0093.

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 Claimants with Initial Claims for Home Health Care	Form and Instruction
DEEOIC Home Health Care Survey OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) from Claimants with Initial Claims for Home Health Care	Form and Instruction
DEEOIC Home Health Care Survey Home Health Care Survey.pdf	Form and Instruction
DEEOIC Home Health Care Survey Home Health Care Survey.pdf	Form and Instruction
Home Health Care Cover Letter.docx Home Health Care Cover Letter	IC Document
Home Health Care Cover Letter.docx Home Health Care Cover Letter	IC Document
ICR A11 Section 280 Clearance - DEEOIC Paper Survey HHC November 2022.docx ICR A11 Section 280 Clearance - DEEOIC Home Health Care	IC Document
ICR A11 Section 280 Clearance - DEEOIC Paper Survey HHC November 2022.docx ICR A11 Section 280 Clearance - DEEOIC Home Health Care	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) from Claimants with Initial Claims for Home Health Care

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

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000

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	4,000	4,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Home Health Care Cover Letter		11/14/2022
ICR A11 Section 280 Clearance - DEEOIC Home Health Care		11/14/2022

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

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