Information Collection

Federal Black Lung Program Customer Experience Survey

IC 255161 under ICR 202308-1225-003 · OMB 1225-0093.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Federal Black Lung Program Customer Experience Survey	Form
Black Lung Survey Instructions.docx	Instruction
Black Lung Survey Instructions.docx	Instruction
Federal Black Lung Program Customer Experience Survey Customer Experience Survey FINAL 8-2-2022.docx	Form
Federal Black Lung Program Customer Experience Survey Customer Experience Survey FINAL 8-2-2022.docx	Form
1225-0093 - A11 Section 280 Clearance - Black Lung 8-4-22.docx Federal Black Lung Program Customer Experience Survey - Supporting Statement	IC Document
1225-0093 - A11 Section 280 Clearance - Black Lung 8-4-22.docx Federal Black Lung Program Customer Experience Survey - Supporting Statement	IC Document

IC Title:

Federal Black Lung Program Customer Experience Survey

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	Federal Black Lung Program Customer Experience Survey	Customer Experience Survey FINAL 8-2-2022.docx		No		Paper Only
Instruction			Black Lung Survey Instructions.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Federal Black Lung Program Customer Experience Survey - Supporting Statement	1225-0093 - A11 Section 280 Clearance - Black Lung 8-4-22.docx	08/04/2022

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