Information Collection

EE-32 (Home Health Care Authorization Request)

IC 243779 under ICR 202602-1240-002 · OMB 1240-0060.

Documents and Forms

Document Name Document Type
Form EE-32 Home Health Care Authorization Request EE-32 (Home Health Care Authorization Request) Form and Instruction
EE-32 Home Health Care Authorization Request EE-32 Home Health Care Authorization Request FEB 2026_Proposed.docx owcpmed.dol.gov/ Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EE-32 (Home Health Care 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) 20 CFR 30.403

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EE-32	Home Health Care Authorization Request	EE-32 Home Health Care Authorization Request FEB 2026_Proposed.docx	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: 35,000	Number of Respondents for Small Entity: 390

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	70,000	70,000
Annual IC Time Burden (Hours)	11,667	11,667
Annual IC Cost Burden (Dollars)	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].