Information Collection Request

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

ICR 202502-0920-003 · OMB 0920-0530 · Received in OIRA

Forms and Documents

Document Name	Status
Form 0920-0530 EEOICPA Dose Reconstruction Introductory Letters & Telephone Interview Form	Modified
Form OCAS-1 EEOICPA Dose Reconstruction Interviews Conclusion Form Form	Modified
Attachment E IRB 16Dec2024.docx Supplementary Document	2025-02-24
Attachment A.3.pdf Supplementary Document	2025-02-24
Attachment A.2.pdf Supplementary Document	2025-02-24
Attachment A.1.pdf Supplementary Document	2025-02-24
Attachment E IRB 04NOV2021.docx Supplementary Document	2021-11-05
Supporting statement B 2025.docx Supporting Statement B	2025-02-24
Supporting statement A 2025.docx Supporting Statement A	2025-02-24
Attachment B 60day FRN.pdf Supplementary Document	2021-10-28
Privacy Act Checklist.doc Supplementary Document	2018-07-03
Attachment A.3.pdf Supplementary Document	2015-01-29
Attachment A.2.pdf Supplementary Document	2015-01-29
Attachment A.1.pdf Supplementary Document	2015-01-29

IC Document Collections

IC ID	Document Title	Status
6981	EEOICPA Dose Reconstruction Introductory Letters & Telephone Interview Form	Modified
188308	EEOICPA Dose Reconstruction Interviews Conclusion Form Form	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CDC
OMB Control No	0920-0530
Type of Information Collection	Reinstatement with change of a previously approved collection
Previous ICR Reference No	202110-0920-006
Agency Tracking No	0920-0530
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31