OWCP Customer Experience Survey for Feedback on Claimants Who Recently Received a Denied Decision

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⚠️ Notice: This information collection may be referencing outdated material.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
Black Lung Survey- Denied Claim - Instructions Updated 8-2-2023 (002) (003).docx Instruction
Black Lung Survey- Denied Claim - Instructions Updated 8-2-2023 (002) (003).docx Instruction
CX Survey - Denied Claim CX Survey - Denied Claim 8-24-2023 - Final.docx Form
CX Survey - Denied Claim CX Survey - Denied Claim 8-24-2023 - Final.docx Form
1225-0093 - A11 Section 280 Clearance - Black Lung-Denied Claim 8-2-2023.docx Supporting Statement IC Document
1225-0093 - A11 Section 280 Clearance - Black Lung-Denied Claim 8-2-2023.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	OWCP Customer Experience Survey for Feedback on Claimants Who Recently Received a Denied Decision	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
Instruction			Black Lung Survey- Denied Claim - Instructions Updated 8-2-2023 (002) (003).docx		No		Paper Only
Form	N/A	CX Survey - Denied Claim	CX Survey - Denied Claim 8-24-2023 - Final.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
Supporting Statement	1225-0093 - A11 Section 280 Clearance - Black Lung-Denied Claim 8-2-2023.docx	08/24/2023

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