EE-26 (Rehabilitative Therapies Authorization Request)

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

OMB: 1240-0060

IC ID: 243776

Information Collection (IC) Details

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EE-26 (Rehabilitative Therapies 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-26 Rehabiltative Therapies Authorization Request EE-26 Rehabilitative Therapies Authorization Request.pdf https://owcpmed.dol.gov/ Yes Yes Fillable Fileable

Workforce Management Worker Safety

DOL/OWCP-11  81 FR 25765

1,250 5
   
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 2,500 0 0 2,100 0 400
Annual IC Time Burden (Hours) 417 0 0 350 0 67
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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