Information Collection

EE -5B - Supplemental Employment Evidence - DOE Contractors

IC 251536 under ICR 202603-1240-001 · OMB 1240-0002.

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Information Collection (IC) Details

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IC Title:	EE -5B - Supplemental Employment Evidence - DOE Contractors	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 30 CFR 30.106

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/OWCP-11	FR Citation: 81 FR 25868

Number of Respondents: 6,816	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,816	6,816
Annual IC Time Burden (Hours)	3,408	3,408
Annual IC Cost Burden (Dollars)	2,308	2,308

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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