Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0093 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) Form and Instruction
1 DEEOIC Phone Survey DEEOIC Claimaint Survey v2.pdf Form and Instruction
ICR A11 Section 280 Clearance - DEEOIC Paper Survey Development Letter Oct 2021.docx Justification Document - DEEOIC Survey IC Document

Information Collection (IC) Details

IC Title:	Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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	1	DEEOIC Phone Survey	DEEOIC Claimaint Survey v2.pdf		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification Document - DEEOIC Survey	ICR A11 Section 280 Clearance - DEEOIC Paper Survey Development Letter Oct 2021.docx	11/22/2021

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