DEEOIC Part E Final Decision Survey and Letter

U.S. Department of Labor

Office of Workers’ Compensation Programs
Division of Energy Employees Occupational
Illness Compensation
Washington, D.C. 20210

Dear Claimant,
Our records indicate that you recently received a Final Decision on your Part E (Wage Loss/Impairment)
Lump-Sum Compensation claim from the Division of Energy Employees Occupational Illness
Compensation (DEEOIC). We are very interested in receiving feedback on your experience with DEEOIC.
Your participation in the enclosed Customer Experience Survey will help us improve the claimant/
customer experience. We appreciate your assistance in helping us determine what is working and what
may be improved. The following survey is confidential. Please return this survey using the enclosed
postage paid envelope by XX/XX/2023.
Thank you for your participation.
Stakeholder Engagement
Branch of Outreach and Technical Assistance
Division of Energy Employees Occupational Illness Compensation

U.S. Department of Labor

Over

Office of Workers’ Compensation Programs
Division of Energy Employees Occupational Illness Compensation
200 Constitution Ave, NW, Room C-3510
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

I am satisfied with the service I received from Division of Energy Employees
Occupational Illness Compensation (DEEOIC).
The process leading up to receiving a final decision on my Wage Loss/Impairment claim
increased my trust in the DEEOIC.

5

4

3

2

1

n/a

5

4

3

2

1

n/a

I have been able to get my questions answered.

5

4

3

2

1

n/a

It was easy to complete what I needed to do to receive a final decision on my Wage
Loss/Impairment claim.
It took a reasonable amount of time to receive a final decision on my Wage
Loss/Impairment claim.

5

4

3

2

1

n/a

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

When considering your claim experience from start to finish, please list
or describe the “pain points” and “bright spots” of your experience.
Pain Point:

Do you have additional feedback related to your experience
filing a Wage Loss/Impairment claim?

An interaction or step in the process that caused a problem,
frustration, or resulted in a negative experience.

Bright Spot: An interaction or step in the process that went smoothly, or
resulted in a positive experience.
Pain Points:

Would you like to speak on the telephone with our Customer
Experience Team regarding your experience filing your Wage
Loss/Impairment claim? Yes 
No 
Bright Spots:

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

OMB Control Number: 1225-0093
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-3510
Washington, D.C. 20210

EQUITY ASSESSMENT
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. Thus, 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.
Advancing 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. We want to know if you feel like your own personal circumstances have made it difficult for you to navigate this
program.
By completing this equity assessment, you will help us to identify and remove barriers in accessing benefits available from OWCP/DEEIOC, so that we can
ensure equitable access to program services and benefits.

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

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-3510, Washington, D.C. 20210 and
reference
OMB 1225-0093. Note: Please do not return the completed form to this address.
Control Number

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