Information Collection

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

IC 261458 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.