Supplemental Supporting Statement, Customer Satisfaction Survey and Conference Evaluation Clearance Form

OMB Approval No. 1225-0059

CUSTOMER SATISFACTION SURVEY AND CONFERENCE EVALUATION CLEARANCE FORM

A. SUPPLEMENTAL SUPPORTING STATEMENT

A.1. Title:	OWCP Services Stakeholder Survey
A.2. Compliance with 5 CFR 1320.5: Yes X____ No _____		A.3. Assurances of confidentiality: No confidential data will be collected.
A.4. Federal cost: $ 400 Includes cost of the Survey Monkey application ($300) and the cost of paper notifications and surveys ($100).		A.5. Requested expiration date (Month/Year): 11/30/12
A.6. Burden Hour estimates: a. Number of Respondents: 1,500 a.1. % Received Electronically 95% a.2 % Received on Paper 5% b. Frequency: Once c. Average Response Time: 5 Minutes d. Total Annual Burden Hours: 125 hours		A7. Does the collection of information employ statistical methods? X_ No ___ Yes (Complete Section B and attach BLS review sheet).

A.8. Abstract:

The Office of Workers' Compensation Programs (OWCP) administers four major disability compensation programs that provide wage replacement benefits, medical treatment, vocational rehabilitation and other benefits to certain workers or their dependents who experience work-related injury or occupational disease.

These programs, the Energy Employees Occupational Illness Compensation program, the Federal Employees' Compensation Program, the Longshore and Harbor Workers' Compensation Program, and the Coal Mine Workers’ Compensation Program, serve the specific employee groups who are covered under the relevant statutes and regulations by mitigating the financial burden resulting from workplace injury.

In administering the programs, OWCP seeks to protect the interests of eligible workers, employers and the Federal Government by ensuring timely and accurate claims adjudication and provision of benefits, by responsibly administering the funds authorized for this purpose, and by restoring injured workers to gainful work when permitted by the effects of the injury.

In its commitment to continuous improvement of our services with the ultimate goal of achieving total customer satisfaction OWCP seeks to contact known stakeholders to ascertain the quality of recent services provided by the Agency through the use of a customer satisfaction survey. The survey will be opened for a three (3) month period of time.

OWCP will contact “known” stakeholders by e-mail and/or mail requesting their participation in a short survey designed to assess our effectiveness in meeting their needs. Known stakeholders include; claimants, employing agencies, insurance companies, rehabilitation nurses, etc. All survey responses will be anonymous in that no names or email addresses will be submitted or captured as part of the survey.

1) Email correspondence will be sent from each of the four programs to their stakeholders providing a direct link to the programs home page where the survey link can be found.

2) Since a large population of the claimants in the Longshore and Harbor Workers’ Compensation Programs have limited internet access, a paper version of web-based survey will be included as part of the regular mailed correspondence between the program and the claimants. However, a written link to the on-line survey will be provided for those with internet access may participate using the web-based survey.

3) The Federal Employees’ Compensation Program will also provide the web-based survey link in a one page stuffer with their regular CA-1032 form mailings to their claimants.

4) The Coal Mine Workers’ Compensation Program will leverage the National Coalition of Black Lung and Respiratory Clinics, Inc., to provide links of the survey for medical providers and the United Mine Workers of America to provide links of the survey to individual claimants.

The respondents will first be categorized by stakeholder type (claimant or healthcare provider) and the Agency’s office they received service from. They will then be asked four questions that measure quality of service the Agency provided.

OWCP will also attempt to survey currently “unknown” users through:

A notice on the four OWCP Program web pages, requesting that stakeholders agree to participate in an online survey designed to assess our effectiveness in meeting their needs, along with a link to the automated online survey will be provided.

Program Official Vincent Alvarez, OWCP	Date March 1, 2011	Departmental Clearance Officer Michel Smyth	Date March 1, 2011