OWCP Paper Survey for Medical Travel Reimbursement (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⚠️ Notice: This information collection may be referencing outdated material.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
OWCP Paper Survey for Medical Travel Reimbursement (DEEOIC) Form and Instruction
Medical Travel Survey Medical Travel Survey.pdf Form and Instruction
ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement January 2022.docx ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement January 2022 IC Document

Information Collection (IC) Details

IC Title:	OWCP Paper Survey for Medical Travel Reimbursement (DEEOIC)	Agency IC Tracking Number:

IC Status: Removed

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	NA	Medical Travel Survey	Medical Travel Survey.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
ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement January 2022	ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement January 2022.docx	02/08/2022

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