Claims Under the Radiation Exposure Compensation Act (RECA)

Documents and Forms

Document Name Document Type
Form OMB Number 1105-00 Claims Under the Radiation Exposure Compensation Act (RECA) Form and Instruction
OMB Number 1105-00 RECA Uranium Mine RECA Uranium Mine_revised_091311.pdf www.usdoj.gov/civil/torts/const/reca/claimform.htm Form and Instruction
OMB Number 1105-00 RECA Uranium Ore RECA Uranium Ore_revised_091311.pdf www.usdoj.gov/civil/torts/const/reca/claimform.htm Form and Instruction
OMB 1105-0052 RECA Downwinder Claim Form RECA DOWNWINDER CLAIM FORM_25_07_23.docx Form and Instruction
OMB #1105-0052 RECA onsite participant claim form RECA ONSITE PARTICIPANT CLAIM FORM_25_07_23.docx Form and Instruction
OMB #1103-0052 RECA Uranium Worker Claim Form RECA URANIUM WORKER CLAIM FORM_25_07_23 jcb.docx Form and Instruction
OMB #1103-0052 RECA Manhattan Project Waste Claim Form RECA MANHATTAN PROJECT WASTE CLAIM FORM_25_07_23.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claims Under the Radiation Exposure Compensation Act (RECA)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OMB Number 1105-0052	RECA Uranium Mine	RECA Uranium Mine_revised_091311.pdf	http://www.usdoj.gov/civil/torts/const/reca/claimform.htm	Yes	No	Printable Only
Form and Instruction	OMB Number 1105-0052	RECA Uranium Ore	RECA Uranium Ore_revised_091311.pdf	http://www.usdoj.gov/civil/torts/const/reca/claimform.htm	Yes	No	Printable Only
Form and Instruction	OMB 1105-0052	RECA Downwinder Claim Form	RECA DOWNWINDER CLAIM FORM_25_07_23.docx		Yes	Yes	Fillable Fileable
Form and Instruction	OMB #1105-0052	RECA onsite participant claim form	RECA ONSITE PARTICIPANT CLAIM FORM_25_07_23.docx		Yes	Yes	Fillable Fileable
Form and Instruction	OMB #1103-0052	RECA Uranium Worker Claim Form	RECA URANIUM WORKER CLAIM FORM_25_07_23 jcb.docx		Yes	Yes	Fillable Fileable
Form and Instruction	OMB #1103-0052	RECA Manhattan Project Waste Claim Form	RECA MANHATTAN PROJECT WASTE CLAIM FORM_25_07_23.docx		Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	5,000	5,000
Annual IC Cost Burden (Dollars)	50,000	50,000

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.