DEEOIC Home Health Care Survey

U.S. Department of Labor

Over

Office of Workers’ Compensation Programs
Division of Energy Employees Occupational Illness Compensation
200 Constitution Ave, NW, Room C-3321
Washington, D.C. 20210

CUSTOMER EXPERIENCE SURVEY
Please agree or disagree with the following statements by
circling a numerical response:

Strongly
Strongly
Agree Neutral Disagree
Agree
Disagree

N/A

The process leading up to receiving a decision on my initial home health care claim
increased my trust in the Division of Energy Employees Occupational Illness
Compensation (DEEOIC).

5

4

3

2

1

n/a

I am satisfied with the service I received from DEEOIC related to my home health care
claim.

5

4

3

2

1

n/a

My questions about home health care have been answered throughout the process.

5

4

3

2

1

n/a

It was easy to complete what I needed to do to receive a decision on my home health
care claim.

5

4

3

2

1

n/a

It took a reasonable amount of time to receive a decision on my home health care claim.

5

4

3

2

1

n/a

I understood what was being asked of me throughout the process.

5

4

3

2

1

n/a

The employees I interacted with were helpful.

5

4

3

2

1

n/a

Do you have additional feedback related to your experience filing for
home health care?

Would you like to speak with our
Customer Experience Team regarding
your experience filing your initial home
health care authorization?
Yes



No



If yes, please provide your name and
telephone number:
Name:___________________________
Phone:___________________________

The OMB control number for this collection is 1225-0093 and expires on 02/29/2024. According to the Paperwork Reduction Act of 1995, no person is required to respond to a collection of
information unless such collection displays a valid OMB control number. The obligation to respond to this collection is voluntary. We estimate it takes about 5 minutes to complete this
collection of information, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing the collection of information.
Please send comments regarding the burden estimate or any other aspect of this collection of information to the U.S. Department of Labor, DEEOIC, 200 Constitution Ave., NW, Room C-3321,
Washington, D.C. 20210 and reference OMB Control Number 1225-0093.
OMB Control Number: 1225-0093
Note: Please do not return the completed form to this address.
Expiration Date: 02/29/2024

U.S. Department of Labor

Office of Workers’ Compensation Programs
Division of Energy Employees Occupational Illness Compensation
200 Constitution Ave, NW, Room C-3321
Washington, D.C. 20210

EQUITY ASSESSMENT
Creating equity in our program means recognizing that different people have different circumstances. Some people face conditions and circumstances
that make it more difficult to achieve the same goals.
“Equity data” describes aspects of your personal identity. DEEOIC does not collect this type of data, however we want to know if you feel like your
own personal circumstances have made it difficult for you to navigate this program.
OWCP/DEEOIC is committed to finding ways to focus on equity for all, including people who have been historically marginalized or adversely affected
by inequality. We strive to best serve all our customers, including racial and ethnic minorities, persons with disabilities, the LGBTQ+ community, rural
communities, and other underserved populations. We want to improve program accessibility and inclusion.

Keeping the above information in mind,
please indicate if you’ve experienced
challenges with our program because of your:

Ability or disability status
Racial or ethnic identity
Age
Sex/Gender identity
Sexual orientation
Veteran status
Religion
Social class
Geographic location (rural/remote)
Other________________

Based on your selection(s) to the left, how can DEEOIC better address
your specific needs?












Please agree or disagree with the following statements by circling a numerical response:

Strongly
Agree

Agree

Neutral

Disagree

Strongly
Disagree

N/A

I feel comfortable talking with DEEOIC
representatives about the unique issues I face.

5

4

3

2

1

n/a

I am treated fairly by DEEOIC representatives.

5

4

3

2

1

n/a

I am able to find and access the correct information
and tools from DEEOIC to achieve my goals.

5

4

3

2

1

n/a

OMB Control Number: 1225-0093
Expiration Date: 02/29/2024