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pdf[SURVEY PREVIEW MODE] Office of Workers' Compensation Programs Customer Satisfaction Survey
Office of Workers' Compensation Programs Customer Satisfaction Survey
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1. Introduction ----------------------------------------------------------------OMB No. 1225-0059
Welcome!
The Office of Workers’ Compensation Programs is committed to continuous improvement of our
services with the ultimate goal of achieving total customer satisfaction. We would greatly appreciate if
you would answer a short survey and let us know how well we assisted you. This survey of seven
questions should take no more than five minutes to complete.
The intent of this survey is to capture your feedback on the professionalism and responsiveness of our
staff. Please do not respond on the basis of your satisfaction with the outcome of a claim. If you are not
satisfied with the outcome of a claim, other, more effective means are available to you including
providing additional information and appealing the decision directly with the administering Program.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection
of information unless such collection displays a valid OMB control number. Public reporting burden for
this collection of information is estimated to average 5 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information. The obligation to respond to this collection
is voluntary. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of
the Chief Information Officer, Attention: Departmental Clearance Officer, 200 Constitution Avenue, N.
W., Room N-1301, Washington, DC 20210 or email [email protected] and reference the
OMB Control Number 1225-0059. Note: Please do not return the completed survey application to this
address.
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2. Survey Participant
1. Please indicate your role (select one):
Claimant
Provider
Other (please specify - e.g., Insurance company, self-insured employer, rehabilitation counselor, etc.)
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[SURVEY PREVIEW MODE] Office of Workers' Compensation Programs Customer Satisfaction Survey
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3. Office Contacted
2. Which benefit program did you most recently contact?
Federal Employees Compensation
Black Lung Benefits
Longshore and Harbor Workers' Compensation (includes Defense Base Act)
Energy Employees Occupational Compensation
3. Please indicate which specific program office you most recently contacted (select one):
Division of Federal Employees’ Compensation National Office
Division of Federal Employees’ Compensation District Office
Division of Energy Employees Occupational Illness Compensation National Office
Division of Energy Employees Occupational Illness Compensation District Office
Division of Energy Employees Occupational Illness Compensation Resource Center
Division of Longshore and Harbor Workers’ Compensation National Office
Division of Longshore and Harbor Workers’ Compensation District Office
Division of Coal Mine Workers’ Compensation National Office
Division of Coal Mine Workers’ Compensation District Office
Medical Benefit (ACS Central Bill Processing)
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4. Response Time
4. Overall, how satisfied were you with the timeliness of the response provided to you by the
representative?
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
Please add any additional comments.
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5. Knowledge of individual providing assistance
5. Do you agree or disagree? The representative who assisted you was knowledgeable about the
subject matter.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Please add any additional comments.
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6. Characteristics of Your Representative
6. How well do each of the following words describe the representative who assisted you?
Excellent
Good
Fair
Poor
Communicates
Clearly
Professional
Responsive
Courteous
Other
(please specify)
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7. Overall Satisfaction
7. Overall, how satisfied were you with the representative who assisted you?
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
Please add any additional comments.
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8. Completed
Thank you for your feedback! Your responses will help us improve service to our claimants and other
stakeholders.
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| File Type | application/pdf |
| File Title | [SURVEY PREVIEW MODE] Office of Workers' Compensation Programs Customer Satisfaction Survey |
| File Modified | 2011-02-23 |
| File Created | 2011-02-23 |