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EE-22 (General Medical Authorization Request)
Division of Energy Employees Occupational Illnesses Compensation (DEEOIC) Authorization Request Forms
OMB: 1240-0060
IC ID: 243774
OMB.report
DOL/OWCP
OMB 1240-0060
ICR 202602-1240-002
IC 243774
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
EE-22 (General Medical Authorization Request)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
20 CFR 30.700
20 CFR 30.400(a)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
EE-22
General Medical Authorization Request
EE-22 General Medical Authorization Request FEB 2026_Proposed.docx
https://owcpmed.dol.gov/
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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:
1,500
Number of Respondents for Small Entity:
393
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
3,000
0
0
0
0
3,000
Annual IC Time Burden (Hours)
500
0
0
0
0
500
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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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