1225-0093 - OWCP Black Lung - Pending Claims

Request for Approval under the “Generic Clearance for Improving Customer Experience: OMB Circular A-11, Section 280 Implementation”

(OMB Control Number: 1225-0093)

TITLE OF INFORMATION COLLECTION: Customer Experience Survey for feedback on claimants with a pending claim.

PURPOSE OF COLLECTION: Paper survey designed to identify pain and positive points of our customers at different stages in the claim process. To determine if Black Lung claimants are utilizing the C.O.A.L. (Claimant Online Access Link. We will use this information to improve our claimant experience.

TYPE OF ACTIVITY: (Check one)

[ X ] Customer Research (Interview, Focus Groups)

[ ] Customer Feedback Survey

[ ] User Testing

ACTIVITY DETAILS

1. How will you collect the information? (Check all that apply)
   
   

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ X ] Mail

[ X ] Other, Explain If customer request a call they will receive a call back and their concerns and/or comments will be documented.

2. Who will you collect the information from?

The Black Lung Program will collect information from 500 claimants in different stages of the claim process; 250 claimants will be pre-SSAE (Schedule for Submission of Additional Evidence) with no preliminary determination issued yet and 250 claimants will be post-SSAE with a preliminary determination on record, but no Proposed Decision and Order (PDO) issued yet.  Those in the pre-SSAE category would have received an initial development letter (requesting additional info or stating no additional info needed at this time) and medical authorization to schedule their DOL sponsored pulmonary evaluation.

At the District Office level there are two decisions rendered – Schedule for Submission of Additional Evidence (SSAE) and Proposed Decision and Order (PDO).  The SSAE is a preliminary determination that is made based on the evidence of record at the time.  That decision, which includes dependency, employment evidence, liability determination, and DOL sponsored complete pulmonary evaluation, provides all parties with set timeframes in which to submit new evidence and/or rebuttal evidence.  Once those established timeframes have expired, the PDO is issued either affirming or reversing the SSAE determination. The PDO can then be appealed to the Office of Administrative Law Judges (OALJ).

3. How will you ask a respondent to provide this information?

The respondent will be asked to complete the paper survey form and mail it back in the business return envelope provided within 30 days.

4. What will the activity look like?

The mailed package will include a cover letter explaining the purpose of the collection.

• The Survey will consist of 5 customer experience questions in which the claimant will have the option to select from Strongly Agree, Agree, Neutral, Disagree, Strongly Disagree, or N/A.

• One Question about the C.O.A.L Portal (Claimant Online Access Link) will give the Black Lung Program a better understanding of the percentage of claimants that use the portal and if not why. This question gives respondents multiple options to select from.

• Two Questions in the Barriers to Access Survey section. One asking if in their interactions with the Federal Black Lung program, have they experienced difficulties due to different factors. If the respondent responds yes to this question, they are prompted to check options provided or if they encountered a problem not on the list, space is provided for feedback. Under this same question the respondent is then asked to identify reason they believe may have contributed to these difficulties. They are provided with several options. Space provided if they want to share additional information. The other question ask their opinion if miners and survivors generally have problems in filling claims under the Black Lung Benefits Act. If the respondent responds yes, they are asked to identify reasons from a list that may contribute to these problems. Space is provided to provide reasons not listed. There is also space for an additional information that the claimant would like to share about the problems that in their opinion miners and survivors may face.

• Space for Other General Comments or Suggestions for improving our Service.

• Yes or no question asking if they would like to talk to a Federal Black Lung Representative

5. Please provide your question list.

See attachment.

Please make sure that all instruments, instructions, and scripts are submitted with the request.

6. When will the activity happen?

The survey will be mailed as soon as possible after approval. An email will be sent to Black Lung staff letting them know the survey is being sent out to customers in case they receive calls about the survey. A post regarding the survey will be made on the DCMWC website.

7. Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants?

[ ] Yes [ X ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden Hours
Claimants	500	5 Minutes	42
Totals	500	5 Minutes	42

CERTIFICATION:

I certify the following to be true:

1. The collections are voluntary;

2. The collections are low-burden for respondents (based on considerations of total burden hours or burden-hours per respondent) and are low-cost for both the respondents and the Federal Government;

3. The collections are non-controversial and do not raise issues of concern to other Federal agencies;

4. Any collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the near future;

5. Personally identifiable information (PII) is collected only to the extent necessary and is not retained;

6. Information gathered is intended to be used for general service improvement and program management purposes

7. Upon agreement between OMB and the agency aggregated data may be released as part of A-11, Section 280 requirements only on performance.gov. Summaries of customer research and user testing activities may be included in public-facing customer journey maps.

8. Additional release of data will be coordinated with OMB.

Name: Kenny Lowe, Equity Coordinator

All instruments used to collect information must include:

OMB Control No. 1225-0093

Expiration Date: 02/29/2024

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