DEEOIC Authorized Representative Survey

U.S. Department of Labor

Office of Workers’ Compensation Programs
Division of Energy Employees Occupational Illness Compensation
200 Constitution Ave, NW, Room C-3321
Washington, D.C. 20210

Dear Authorized Representative,
Our records indicate that you have served as an Authorized Representative (AR) under the Energy
Employees Occupational Illness Compensation Act (EEOICPA). As an AR for a case that received a
Final Decision in the last year, we are very interested in receiving feedback on your experience with
DEEOIC.
This survey is focused on gathering feedback reflecting on your interactions as an Authorized
Representative, specifically about the process leading to the issuance of the Final Decision. Your
participation in the enclosed Customer Experience Survey will help us improve both the claimant and
AR experience.
We appreciate your assistance in helping us determine what is working and what may be improved.
The following survey is confidential. Please return this survey using the enclosed postage paid
envelope by July 15, 2022.
Thank you for your participation. 
Stakeholder Engagement 
Branch of Outreach and Technical Assistance
Division of Energy Employees Occupational Illness Compensation 

OMB Control Number: 1225-0093
Expiration Date: 2/29/2024

U.S. Department of Labor

Office of Workers’ Compensation Programs
Division of Energy Employees Occupational Illness Compensation
200 Constitution Ave, NW, Room C-3321
Washington, D.C. 20210

Over

CUSTOMER EXPERIENCE SURVEY
Please indicate your answers to the statements below by
circling a response.

Outstanding

Above
Average

Average

Below
Average

Poor

N/A

5

4

3

2

1

n/a

Strongly
Agree

Agree

Neutral

Disagree

Strongly
Disagree

N/A

I trust DEEOIC to fulfill our country’s commitment to nuclear
workers and their families.

5

4

3

2

1

n/a

I understand my role and responsibili es as an
Authorized Representa ve.

5

4

3

2

1

n/a

It took a reasonable amount of me for the claimant to
receive a final decision.

5

4

3

2

1

n/a

It was easy to complete what I needed to do for the
claimant to receive a final decision.

5

4

3

2

1

n/a

I have been able to get my ques ons answered.

5

4

3

2

1

n/a

In my role as an Authorized Representa ve,
I have been treated fairly. 

5

4

3

2

1

n/a

The DEEOIC employees I have interacted with were helpful.

5

4

3

2

1

n/a

I have been informed of/have access to resources that indicate
the length of me each step in the claims process takes.

5

4

3

2

1

n/a

DEEOIC provides the appropriate informa on and tools
necessary to do my job as an Authorized Representa ve.

5

4

3

2

1

n/a

Yes

No

n/a

‐

‐

‐

DEEOIC events I have par cipated in have been helpful.

5

4

3

2

1

n/a

What resources have you found most useful in helping
understand the program and assis ng your claimant?

DEEOIC
Website

Resource Center
Employees

Claims
Examiners

Outreach
Events

Please rate your experience with DEEOIC as an
Authorized Representa ve.

I have been informed about DEEOIC outreach events
(webinars, in‐person events, AR workshops, etc).

Other: _______________
OMB Control Number: 1225-0093

U.S. Department of Labor

Office of Workers’ Compensation Programs
Division of Energy Employees Occupational Illness Compensation
200 Constitution Ave, NW, Room C-3321
Washington, D.C. 20210

How can the Energy Program help you be er assist the claimant that you represent?

Do you have addi onal feedback related to your experience as an Authorized Representa ve?

Would you like to speak with our Customer Experience Team?
Yes



No



If yes, please provide your name and telephone number:
Name:_________________________________________
Phone:_________________________________________

If you would like to be added to our Program and Policy Updates email distribu on list, please provide your email address:
______________________________________________________
The OMB control number for this collection is 1225-0093 and expires on 02/29/2024. According to the Paperwork Reduction Act of 1995, no person is required to respond to a collection of
information unless such collection displays a valid OMB control number. The obligation to respond to this collection is voluntary. We estimate it takes about 5 minutes to complete this
collection of information, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing the collection of information. Please send comments regarding the burden estimate or any other aspect of this collection of information to the U.S. Department of Labor, DEEOIC, 200 Constitution Ave., NW,
Room C-3321, Washington, D.C. 20210 and reference OMB Control Number 1225-0093.
Note: Please do not return the completed form to this address.
OMB Control Number: 1225-0093