EE-22 (General Medical Authorization Request)

Division of Energy Employees Occupational Illnesses Compensation (DEEOIC) Authorization Request Forms

OMB: 1240-0060

IC ID: 243774

Information Collection (IC) Details

View Information Collection (IC)

EE-22 (General Medical Authorization Request)
 
No Modified
 
Mandatory
 
20 CFR 30.400(a) 20 CFR 30.700

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) (11).docx https://owcpmed.dol.gov/ Yes Yes Fillable Fileable

Workforce Management Worker Safety

DOL/OWCP-11  81 FR 25765

1,500 393
   
Individuals or Households
 
   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 -12,700 0 15,700
Annual IC Time Burden (Hours) 500 0 0 -2,117 0 2,617
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy