Information Collection Request

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

ICR 202602-1240-002 · OMB 1240-0060 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form EE-32 Home Health Care Authorization Request Form and Instruction Modified Available
Form EE-30 Transplant Authorization Request Form and Instruction Modified Repair queued
Form EE-28 Transportation Authorization Request Form and Instruction Modified Available
Form EE-26 Rehabiltative Therapies Authorization Request Form and Instruction Modified Available
Form EE-24 Durable Medical Equipment Authorization Request Form and Instruction Modified Available
Form EE-22 General Medical Authorization Request Form and Instruction Modified Available
Justification for 1240-0060 DEEOIC Authorization Request Forms_20260227.docx Justification for No Material/Nonsubstantive Change Uploaded 2026-02-27 Repair queued
EE-32 Home Health Care Authorization Request FEB 2026.docx Supplementary Document Uploaded 2026-02-27 Repair queued
EE-30 Transplant Authorization Request FEB 2026.docx Supplementary Document Uploaded 2026-02-27 Repair queued
EE-28 Transportation Authorization Request FEB 2026.docx Supplementary Document Uploaded 2026-02-27 Available
EE-26- Rehabilitative Therapies Authorization Request FEB 2026.docx Supplementary Document Uploaded 2026-02-27 Available
EE-24 Durable Medical Equipment Authorization Request FEB 2026.docx Supplementary Document Uploaded 2026-02-27 Repair queued
EE-22 General Medical Authorization Request FEB 2026.docx Supplementary Document Uploaded 2026-02-27 Repair queued
Supporting Statement 1240-0060_06 21_2024_FINAL_MN_clean.docx Supporting Statement A Uploaded 2024-06-21 Available
20 CFR Part 30.pdf Supplementary Document Uploaded 2020-09-24 Available
42 USC 7384 et seq.pdf Supplementary Document Uploaded 2020-09-24 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
243779 EE-32 (Home Health Care Authorization Request) Form and Instruction ModifiedHome Health Care Authorization Request
243779 EE-32 (Home Health Care Authorization Request) Form and Instruction Modified
243778 EE-30 (Transplant Authorization Request) Form and Instruction ModifiedTransplant Authorization Request
243778 EE-30 (Transplant Authorization Request) Form and Instruction Modified
243777 EE-28 (Transportation Authorization Request) Form and Instruction ModifiedTransportation Authorization Request
243777 EE-28 (Transportation Authorization Request) Form and Instruction Modified
243776 EE-26 (Rehabilitative Therapies Authorization Request) Form and Instruction ModifiedRehabiltative Therapies Authorization Request
243776 EE-26 (Rehabilitative Therapies Authorization Request) Form and Instruction Modified
243775 EE-24 (Durable Medical Equipment Authorization) Form and Instruction ModifiedDurable Medical Equipment Authorization Request
243775 EE-24 (Durable Medical Equipment Authorization) Form and Instruction Modified
243774 EE-22 (General Medical Authorization Request) Form and Instruction ModifiedGeneral Medical Authorization Request
243774 EE-22 (General Medical Authorization Request) Form and Instruction Modified
ICR Details
1240-0060 202602-1240-002
Active 202503-1240-002
DOL/OWCP
Division of Energy Employees Occupational Illnesses Compensation (DEEOIC) Authorization Request Forms
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 02/27/2026
Retrieve Notice of Action (NOA) 02/27/2026
  Inventory as of this Action Requested Previously Approved
07/31/2027 07/31/2027 07/31/2027
98,020 0 98,020
16,337 0 16,337
0 0 0

The Office of Workers’ Compensation Programs (OWCP) is the primary agency responsible for administration of the Energy Employees Occupational Illness Compensation Program Act of 2000, as amended (EEOICPA), 42 U.S.C. § 7384 et seq. EEOICPA provides for the payment of compensation to covered employees and, where applicable, survivors of deceased employees, who sustained either an “occupational illness” or a “covered illness” in the performance of duty for the Department of Energy and certain of its contractors and subcontractors. One element of the compensation provided to covered employees is medical benefits for the treatment of their occupational or covered illnesses that are accepted as compensable. OWCP contracts with a private sector bill processing agent that handles many of the tasks associated with paying bills for medical treatment provided to covered employees under EEOICPA. This bill processing agent uses an automated system that matches incoming bills with the authorized medical treatment of covered employees before it issues payments, and a provider of medical treatment, supplies or services to covered employees must provide the bill processing agent with information necessary for creation of an authorization within the agent’s automated system before a bill can be paid. The collection of this information is authorized by 20 CFR 30.400(a) and (c), 30.403, 30.404(b) and 30.700. The information collected by these forms will be used by both OWCP and its bill processing agent in connection with the automated payment of bills submitted by providers of medical treatment, supplies or services. The information submitted, along with other supporting documentation, is used to determine the correct amount to be paid to a provider of medical treatment, supplies or services to beneficiaries under EEOICPA.

US Code: 42 USC 7384 Name of Law: Energy Employees Occupational Illness Compensation Program Act of 2000
  
None

Not associated with rulemaking

  89 FR 9868 02/12/2024
89 FR 46912 05/30/2024
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 98,020 98,020 0 0 0 0
Annual Time Burden (Hours) 16,337 16,337 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$3,466,352
No
    Yes
    Yes
No
No
No
No
Anjanette Suggs 202 354-9660 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/27/2026