DOL OWCP Black Lung - Claimants with Pending Claim

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⚠️ Notice: This information collection may be referencing outdated material.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
DOL OWCP Black Lung - Claimants with Pending Claim Form
Black Lung Survey- Pending Claim - Instructions Updated 5-1-2023 (002).docx Instruction
Black Lung Survey- Pending Claim - Instructions Updated 5-1-2023 (002).docx Instruction
OWCP Black Lung CX Survey - Claimants with a Pending Cla CX Survey-Claimants with a Pending Claim 5-1-2023.docx Form
OWCP Black Lung CX Survey - Claimants with a Pending Cla CX Survey-Claimants with a Pending Claim 5-1-2023.docx Form
1225-0093 - A11 Section 280 Clearance - Black Lung-Pending Claims 5.1.docx 1225-0093 - OWCP Black Lung - Pending Claims IC Document
1225-0093 - A11 Section 280 Clearance - Black Lung-Pending Claims 5.1.docx 1225-0093 - OWCP Black Lung - Pending Claims IC Document

Information Collection (IC) Details

IC Title:	DOL OWCP Black Lung - Claimants with Pending Claim	Agency IC Tracking Number:

IC Status: Unchanged

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	NA	OWCP Black Lung CX Survey - Claimants with a Pending Claim	CX Survey-Claimants with a Pending Claim 5-1-2023.docx		No		Paper Only
Instruction			Black Lung Survey- Pending Claim - Instructions Updated 5-1-2023 (002).docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
1225-0093 - OWCP Black Lung - Pending Claims	1225-0093 - A11 Section 280 Clearance - Black Lung-Pending Claims 5.1.docx	05/01/2023

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