EEOICPA Dose Reconstruction Interviews and Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0530 can be found here:

Documents and Forms

Document Name Document Type
Form No number EEOICPA Dose Reconstruction Interviews and Form Form and Instruction
No number No name Attachment C Telephone Interviews.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EEOICPA Dose Reconstruction Interviews and Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	No number	No name	Attachment C Telephone Interviews.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program Records	FR Citation: 68 FR 55962

Number of Respondents: 4,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,200	4,200
Annual IC Time Burden (Hours)	4,200	4,200
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.