OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

OWCP Black Lung Worker's Compensation Program End-to-End Experience Customer Interviews

IC 256615 under ICR 202308-1225-003 · OMB 1225-0093.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

OWCP Black Lung Worker's Compensation Program End-to-End Experience Customer Interviews
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Claimant Interview Guide- Black Lung.docx Yes Yes Fillable Fileable

Income Security Unemployment Compensation

 

16 0
   
Individuals or Households
 
   75 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 16 0 0 0 0 16
Annual IC Time Burden (Hours) 16 0 0 0 0 16
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Black Lung Consent Form Consent Form_ Black Lung.docx 10/26/2022
1225-0093 Supporting Statement - Black Lung End-to-End Experience Interviews ICR DOL OWCP BlackLung Program Supporting Statement.docx 10/26/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.