Improving Customer Experience (OMB Circular A-11, Section 280 Implementation) for the Department of Labor (DOL)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CX Survey - Denied Claim	Form	New	Repair queued
Customer Experience and Equity Assessment Survey	Form and Instruction	New	Repair queued
Voluntary Demographic Information	Form and Instruction	New	Repair queued
Oxygen and Accessories DME Survey	Form and Instruction	New	Repair queued
Consent Form for Wireframe Testing for Soliciting Feedback for the Department of Labor EBSA Website	Form and Instruction	New	Repair queued
Wireframe Testing for Soliciting Feedback for the Department of Labor EBSA Website	Form and Instruction	New	Repair queued
Customer Experience Survey for Claimants who are Attending Black Lung Outreach Events	Form	New	Repair queued
OWCP Black Lung CX Survey - Claimants with a Pending Claim	Form	New	Repair queued
CareerOneStop Customer Experience Form	Form and Instruction	New	Repair queued
Spanish Language Web Feedback Survey	Form and Instruction	New	Repair queued
EDP Survey Update	Form and Instruction	New	Repair queued
OWCP DEEOIC Outreach Event Feedback Form	Form	New	Repair queued
DEEOIC Part E Final Decision Survey and Letter	Form and Instruction	New	Repair queued
ETA - Job Seeking and Career Advancement Interview Questions	Form and Instruction	New	Repair queued
EBSA Tree Testing Baseline Survey	Form and Instruction	New	Repair queued
EBSA Quantitative Web UX Testing Rapid Survey	Form and Instruction	New	Repair queued
EBSA Customer Interviews Discussion Guide	Form and Instruction	New	Repair queued
EBSA Customer Interviews Recruitment Screener Questions	Form and Instruction	New	Repair queued
DEEOIC Home Health Care Survey	Form and Instruction	New	Repair queued
DEEOIC Resource Center Customer Service Survey	Form and Instruction	New	Repair queued
Federal Black Lung Program Customer Experience Survey	Form	New	Repair queued
Form Form 1 Electronic Survey for Soliciting Feedback for the Heat Illness Prevention Campaign Newsletter	Form	New	Repair queued
CareerOneStop Survey Questions	Form and Instruction	New	Repair queued
Longshore ECOMP-Instrument (1st Survey)	Form and Instruction	New	Repair queued
DEEOIC Authorized Representative Survey	Form and Instruction	New	Repair queued
Customer Feedback at Outreach Event for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	Form and Instruction	New	Repair queued
Longshore ECOMP - Help us Improve Our Program	Form and Instruction	New	Repair queued
Web Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) Energy Document Portal	Form and Instruction	New	Repair queued
DEEOIC Webinar Survey Language	Form and Instruction	New	Repair queued
Medical Travel Survey	Form and Instruction	New	Available
Medical Travel Survey	Form and Instruction	Removed	Available
Form 1 DEEOIC Phone Survey	Form and Instruction	New	Available
Form 1 DEEOIC Phone Survey	Form and Instruction	New	Repair queued
Form 1 Survey for Soliciting Feedback for DEEOIC.	Form and Instruction	New	Available
Template for DOL A11 Section 280 Clearance 9.30.2020.docx	Supplementary Document	Uploaded 2020-10-07	Available
Improving Customer Experience 60-Day.pdf	Supplementary Document	Uploaded 2020-09-30	Available
Supporting Statement B for DOL A 11 Section 280 Improving Customer Experience 9.29.2020.docx	Supporting Statement B	Uploaded 2020-09-30	Available
Supporting Statement A for DOL A 11 Section 280 Improving Customer Experience 9.29.2020.docx	Supporting Statement A	Uploaded 2020-09-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
261458	OWCP Customer Experience Survey for Feedback on Claimants Who Recently Received a Denied Decision	Form	New	CX Survey - Denied Claim
261458	OWCP Customer Experience Survey for Feedback on Claimants Who Recently Received a Denied Decision	Instruction	New
261169	Quantitative Web User Experience Testing (Rapid) Survey for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration Website	Other-Form, Instruction, and Consent Form	New
260777	Customer Experience and Equity Assessment Survey	Form and Instruction	New	Customer Experience and Equity Assessment Survey
260771	Voluntary Demographic Information	Form and Instruction	New	Voluntary Demographic Information
260593	Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	Form and Instruction	New	Oxygen and Accessories DME Survey
260486	Wireframe Testing for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration Website	Form and Instruction	New	Consent Form for Wireframe Testing for Soliciting Feedback for the Department of Labor EBSA Website
260486	Wireframe Testing for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration Website	Form and Instruction	New	Wireframe Testing for Soliciting Feedback for the Department of Labor EBSA Website
260125	Customer Experience Survey for Claimants who are Attending Black Lung Outreach Events	Form	New	Customer Experience Survey for Claimants who are Attending Black Lung Outreach Events
259961	DOL OWCP Black Lung - Claimants with Pending Claim	Form	New	OWCP Black Lung CX Survey - Claimants with a Pending Claim
259961	DOL OWCP Black Lung - Claimants with Pending Claim	Instruction	New
259440	CareerOneStop Customer Experience Form	Form and Instruction	New	CareerOneStop Customer Experience Form
259320	DOL OWCP Division of Energy Employees Occupational Illness Compensation (DEEOIC) - Web Survey for Soliciting Feedback - Spanish	Form and Instruction	New	Spanish Language Web Feedback Survey
259319	DOL OWCP Web Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) Energy Document Portal	Form and Instruction	New	EDP Survey Update
259126	OSHA Voluntary Protection Program (VPP) Participants and Special Government Employee Customer Interviews	Instruction	New
258583	OWCP DEEOIC Outreach Event Feedback Form	Form	New	OWCP DEEOIC Outreach Event Feedback Form
258294	OWCP Focus groups for collecting customer feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	Instruction	New
257874	OWCP Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) - Final Decision on a Part E Wage Loss/Impairment Claim	Form and Instruction	New	DEEOIC Part E Final Decision Survey and Letter
257454	Employee Training Administration- Job Seeking and Career Advancement Customer Interviews	Form and Instruction	New	ETA - Job Seeking and Career Advancement Interview Questions
257303	Tree Testing for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration Website	Form and Instruction	New	EBSA Tree Testing Baseline Survey
257302	Quantitative Web User Experience Testing (Rapid) Survey for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration Website	Form and Instruction	New	EBSA Quantitative Web UX Testing Rapid Survey
257301	Customer Interviews for Soliciting Feedback about the Department of Labor Employment and Benefits Security Administration	Form and Instruction	New	EBSA Customer Interviews Discussion Guide
257300	Recruiting and Screening Customers for Customer Interviews for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration	Form and Instruction	New	EBSA Customer Interviews Recruitment Screener Questions
256742	OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) from Claimants with Initial Claims for Home Health Care	Form and Instruction	New	DEEOIC Home Health Care Survey
256615	OWCP Black Lung Worker's Compensation Program End-to-End Experience Customer Interviews	Instruction	New
256614	OWCP DEEOIC End-to-End Experience Customer Interviews	Instruction	New
255605	Paper Survey for Soliciting Feedback for OWCP Division of Energy Employees Occupational Illness Compensation (DEEOIC) from Resource Center Customers	Form and Instruction	New	DEEOIC Resource Center Customer Service Survey
255161	Federal Black Lung Program Customer Experience Survey	Form	New	Federal Black Lung Program Customer Experience Survey
255161	Federal Black Lung Program Customer Experience Survey	Instruction	New
254662	Electronic Survey for Soliciting Feedback for the Heat Illness Prevention Campaign Newsletter	Form	New	Electronic Survey for Soliciting Feedback for the Heat Illness Prevention Campaign Newsletter
254463	CareerOneStop Customer Experience Form	Form and Instruction	New	CareerOneStop Survey Questions
253908	OWCP Longshore Voluntary Demographic Information	Form and Instruction	New	Longshore ECOMP-Instrument (1st Survey)
253784	Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives	Form and Instruction	New	DEEOIC Authorized Representative Survey
253764	OWCP Customer Feedback at Outreach Event for Division of Energy Employees Occupational Illness Compensation (Paper)	Form and Instruction	New	Customer Feedback at Outreach Event for Division of Energy Employees Occupational Illness Compensation (DEEOIC)
253693	OWCP Longshore ECOMP - Help Us Improve Our Program	Form and Instruction	New	Longshore ECOMP - Help us Improve Our Program
253323	Web Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) Energy Document Portal	Form and Instruction	New	Web Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) Energy Document Portal
253286	OWCP DEEOIC Focus Groups	Instruction	New
251709	OWCP Web-based Survey for Soliciting Webinar Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	Form and Instruction	New	DEEOIC Webinar Survey Language
251501	OWCP Paper Survey for Medical Travel Reimbursement (DEEOIC)	Form and Instruction	New	Medical Travel Survey
251476	OWCP Paper Survey for Medical Travel Reimbursement (DEEOIC)	Form and Instruction	Removed	Medical Travel Survey
251426	OWCP DEEOIC Revised Phone Survey	Instruction	New
250452	Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	Form and Instruction	New	DEEOIC Phone Survey
249532	Phone Survey for Soliciting Feedback for DEEOIC	Form and Instruction	New	DEEOIC Phone Survey
246995	Survey for Soliciting Feedback for DEEOIC.	Form and Instruction	New	Survey for Soliciting Feedback for DEEOIC.

ICR Details

OMB Control No: 1225-0093	ICR Reference No: 202202-1225-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOL/DM	Agency Tracking No: (2020) 1218-0NEW
Title: Improving Customer Experience (OMB Circular A-11, Section 280 Implementation) for the Department of Labor (DOL)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/16/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/16/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2024	36 Months From Approved
Responses	2,001,550	0	0
Time Burden (Hours)	101,125	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection activity provides a means to garner customer and stakeholder feedback in an efficient, timely manner in accordance with the Administration's commitment to improving customer service delivery as discussed in Section 280 of OMB Circular A-11. As discussed in OMB guidance, agencies should identify their highest-impact customer journeys (using customer volume, annual program cost, and/or knowledge of customer priority as weighting factors) and select touchpoints/transactions within those journeys to collect feedback.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 45928	07/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 82521	12/18/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 39

table that charts list of burden

IC Title	Form No.	Form Name
CareerOneStop Customer Experience Form	N/A	CareerOneStop Customer Experience Form
CareerOneStop Customer Experience Form	NA	CareerOneStop Survey Questions
Customer Experience Survey for Claimants who are Attending Black Lung Outreach Events	NA	Customer Experience Survey for Claimants who are Attending Black Lung Outreach Events
Customer Experience and Equity Assessment Survey	NA	Customer Experience and Equity Assessment Survey
Customer Interviews for Soliciting Feedback about the Department of Labor Employment and Benefits Security Administration	NA	EBSA Customer Interviews Discussion Guide
DOL OWCP Division of Energy Employees Occupational Illness Compensation (DEEOIC) - Web Survey for Soliciting Feedback - Spanish	NA	Spanish Language Web Feedback Survey
DOL OWCP Black Lung - Claimants with Pending Claim	NA	OWCP Black Lung CX Survey - Claimants with a Pending Claim
DOL OWCP Web Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) Energy Document Portal	NA	EDP Survey Update
Electronic Survey for Soliciting Feedback for the Heat Illness Prevention Campaign Newsletter	Form 1	Electronic Survey for Soliciting Feedback for the Heat Illness Prevention Campaign Newsletter
Employee Training Administration- Job Seeking and Career Advancement Customer Interviews	N/A	ETA - Job Seeking and Career Advancement Interview Questions
Federal Black Lung Program Customer Experience Survey	NA	Federal Black Lung Program Customer Experience Survey
OSHA Voluntary Protection Program (VPP) Participants and Special Government Employee Customer Interviews
OWCP Black Lung Worker's Compensation Program End-to-End Experience Customer Interviews
OWCP Customer Experience Survey for Feedback on Claimants Who Recently Received a Denied Decision	N/A	CX Survey - Denied Claim
OWCP Customer Feedback at Outreach Event for Division of Energy Employees Occupational Illness Compensation (Paper)	NA	Customer Feedback at Outreach Event for Division of Energy Employees Occupational Illness Compensation (DEEOIC)
OWCP DEEOIC End-to-End Experience Customer Interviews
OWCP DEEOIC Focus Groups
OWCP DEEOIC Outreach Event Feedback Form	N/A	OWCP DEEOIC Outreach Event Feedback Form
OWCP DEEOIC Revised Phone Survey
OWCP Focus groups for collecting customer feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)
OWCP Longshore ECOMP - Help Us Improve Our Program	NA	Longshore ECOMP - Help us Improve Our Program
OWCP Longshore Voluntary Demographic Information	NA	Longshore ECOMP-Instrument (1st Survey)
OWCP Paper Survey for Medical Travel Reimbursement (DEEOIC)	NA	Medical Travel Survey
OWCP Paper Survey for Medical Travel Reimbursement (DEEOIC)	NA	Medical Travel Survey
OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) from Claimants with Initial Claims for Home Health Care	N/A	DEEOIC Home Health Care Survey
OWCP Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) - Final Decision on a Part E Wage Loss/Impairment Claim	N/A	DEEOIC Part E Final Decision Survey and Letter
OWCP Web-based Survey for Soliciting Webinar Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	NA	DEEOIC Webinar Survey Language
Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	1	DEEOIC Phone Survey
Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	N/A	Oxygen and Accessories DME Survey
Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives	NA	DEEOIC Authorized Representative Survey
Paper Survey for Soliciting Feedback for OWCP Division of Energy Employees Occupational Illness Compensation (DEEOIC) from Resource Center Customers	NA	DEEOIC Resource Center Customer Service Survey
Phone Survey for Soliciting Feedback for DEEOIC	1	DEEOIC Phone Survey
Quantitative Web User Experience Testing (Rapid) Survey for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration Website
Quantitative Web User Experience Testing (Rapid) Survey for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration Website	NA	EBSA Quantitative Web UX Testing Rapid Survey
Recruiting and Screening Customers for Customer Interviews for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration	NA	EBSA Customer Interviews Recruitment Screener Questions
Survey for Soliciting Feedback for DEEOIC.	1	Survey for Soliciting Feedback for DEEOIC.
Tree Testing for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration Website	NA	EBSA Tree Testing Baseline Survey
Voluntary Demographic Information	NA	Voluntary Demographic Information
Web Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) Energy Document Portal	NA	Web Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) Energy Document Portal
Wireframe Testing for Soliciting Feedback for the Department of Labor Employment and Benefits Security Administration Website	NA, NA	Wireframe Testing for Soliciting Feedback for the Department of Labor EBSA Website ,   Consent Form for Wireframe Testing for Soliciting Feedback for the Department of Labor EBSA Website

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,001,550	0	0	2,001,550	0	0
Annual Time Burden (Hours)	101,125	0	0	101,125	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/18/2020

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