Information Collection

FECA Claimat Survey Package

IC 193965 under ICR 200909-1225-001 · OMB 1225-0059.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0059 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Injured Worker Survey_v1 3.pdf	Other-Survey
VPAT_SurveyMonkey.pdf	Other-Survey
Claimant Survey Letter.doc	Other-Survey Letter
Supporting Statement (1225-0059).doc Supporting Statement	IC Document

IC Title:

FECA Claimat Survey Package

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	Injured Worker Survey_v1 3.pdf	Yes	Yes	Fillable Fileable
Other-Survey	VPAT_SurveyMonkey.pdf	Yes	Yes	Fillable Fileable
Other-Survey Letter	Claimant Survey Letter.doc	Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,620

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,620	1,620
Annual IC Time Burden (Hours)	405	405
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting Statement (1225-0059).doc	08/03/2010

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