Energy Employees Occupational Illness Compensation Program Act Forms

ICR 202412-1240-003

OMB: 1240-0002

Federal Form Document

Forms and Documents

Document Name	Status
Form EE-13 EEOICP Forms for State Governments Form	Modified
Form EE-7 EEOICP Forms for Private Sector Form	Modified
Form EE-1 English EEOICP Forms for Individuals or Households Form and Instruction	Modified
Supporting Statement for 1240-0002 4 1 25.docx Supporting Statement A	2025-04-01
1240-0002 Supporting regulatory and statutory provisions.docx Supplementary Document	2021-09-16
Form EE-5.pdf Supplementary Document	2021-09-16
Supporting Regulations.pdf Supplementary Document	2013-06-11

IC Document Collections

IC ID	Document Title	Status
251537	EE - 7A - Report of Occupational Illness (Part B)/Report of Covered Illness (Part E)	Modified
251536	EE -5B - Supplemental Employment Evidence - DOE Contractors	Modified
251535	EE 5A - Supplemental Employment Evidence	Modified
178684	EEOICP Forms for State Governments Form	Modified
178683	EEOICP Forms for Private Sector Form	Modified
13934	EEOICP Forms for Individuals or Households Form and Instruction	Modified