EEOICPA Dose Reconstruction Interviews Conclusion Form

Energy Employees Occupational Illness Compensation Program Act Dose Reconstruction Interviews and Forms (EEOICPA)

Documents and Forms

Document Name Document Type
Form OCAS-1 EEOICPA Dose Reconstruction Interviews Conclusion Form Form
OCAS-1 Statement by Claimant Closing Record on a NIOSH Dose Rec Attachment D.doc Form
OCAS-1 Statement by Claimant Closing Record on a NIOSH Dose Rec Attachment D.doc Form
0920-0530 Attachment D_OCAS-1 Attachment D_OCAS-1.docx Form
0920-0530 Attachment D_OCAS-1 Attachment D_OCAS-1.docx Form

Information Collection (IC) Details

IC Title:	EEOICPA Dose Reconstruction Interviews Conclusion Form	Agency IC Tracking Number:	0920-0530

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	OCAS-1	Statement by Claimant Closing Record on a NIOSH Dose Reconstruction	Attachment D.doc		Yes	No	Fillable Printable
Form	0920-0530	Attachment D_OCAS-1	Attachment D_OCAS-1.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: 09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program Records	FR Citation: 76 FR 34706

Number of Respondents: 3,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	300	300
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.