Authorized Representative Survey

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

Dear Authorized Representative,
Our records indicate that you have served as an Authorized Representative (AR) under the Energy
Employees Occupational Illness Compensation Act (EEOICPA). As an AR for a case that received a
Final Decision, we are very interested in receiving feedback on your experience with DEEOIC.
This survey is focused on gathering feedback reflecting on your interactions as an Authorized
Representative, specifically about the process leading to the issuance of the Final Decision. Your
participation in the enclosed Customer Experience Survey will help us improve both the claimant
and AR 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 XXXXX XX, 2024.
Thank you for your participation. 
Stakeholder Engagement 
Branch of Outreach and Technical Assistance
Division of Energy Employees Occupational Illness Compensation 

OMB Control Number: 1225-0093
Expiration Date: 2/29/2024

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

DEEOIC AUTHORIZED REPRESENTATIVE CUSTOMER EXPERIENCE SURVEY
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. Note: Please do not return the completed form to this address.

Please indicate your answers to the statements below by
circling a response.
Based on my experience as an Authorized Representa ve, I
trust DEEOIC to fulfill our country’s commitment to nuclear
workers and their families.

Strongly
Agree

Agree

Neutral

Disagree

Strongly
Disagree

N/A

5

4

3

2

1

n/a

What factors contributed to your trust ra ng? (You may select more than one)

Helpfulness/commitment level of employees
Ability to get my needs addressed
Expecta ons/informa on provided throughout process
Length of me of process

Ease of process
Fairness during process

I understand my role and responsibili es as an Authorized Representa ve.

5

4

3

2

1

N/A

It took a reasonable amount of me for the claimant to receive
a final decision.

5

4

3

2

1

N/A

It was easy to complete what I needed to do for the claimant to
receive a final decision.

5

4

3

2

1

N/A

I have been able to get my ques ons answered.

5

4

3

2

1

N/A

In my role as an Authorized Representa ve, I have been treated
fairly.

5

4

3

2

1

N/A

The DEEOIC employees I have interacted with were helpful.

5

4

3

2

1

N/A

Over

OMB Control Number: 1225-0093

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

Please indicate your answers to the statements below by
circling a response.

Strongly
Agree

Agree

Neutral

Disagree

Strongly
Disagree

N/A

I have been informed of or have access to resources that indicate the length of me each step in the claims process takes. 

5

4

3

2

1

N/A

DEEOIC provides the appropriate informa on and tools necessary to do my job as an Authorized Representa ve.  

5

4

3

2

1

N/A

Outstanding Above Average

Average

Below Average

Poor

N/A

Center
DEEOIC website Resource
Employees

Claims
Examiners

Please rate your experience with DEEOIC as an Authorized Representa ve.
What resources have you found most useful in helping understand the program and assis ng your claimant?  

Outreach Events
(Webinar and In- Other :
Person)

How can the Energy Program help you beƩer assist the claimant that you represent?

Do you have addiƟonal feedback related to your experience as an Authorized RepresentaƟve?

Would you like to speak with our Customer Experience Team
regarding your experience as an Authorized RepresentaƟve?
Yes



No



If yes, please provide your name and telephone number:

Name:_________________________________________
Phone:_________________________________________
OMB Control Number: 1225-0093