Information Collection

OWCP Paper Survey for Medical Travel Reimbursement (DEEOIC)

IC 251501 under ICR 202312-1225-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
OWCP Paper Survey for Medical Travel Reimbursement (DEEOIC)	Form and Instruction
Medical Travel Survey Travel Reimbursement Survey 2-9-2022.pdf	Form and Instruction
Medical Travel Survey Travel Reimbursement Survey 2-9-2022.pdf	Form and Instruction
ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement February 2022 - 2-9-2022.docx ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement February 2022 - 2-9-2022	IC Document
ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement February 2022 - 2-9-2022.docx ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement February 2022 - 2-9-2022	IC Document

IC Title:

OWCP Paper Survey for Medical Travel Reimbursement (DEEOIC)

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
Form and Instruction	NA	Medical Travel Survey	Travel Reimbursement Survey 2-9-2022.pdf		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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	2,000	2,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement February 2022 - 2-9-2022	ICR A11 Section 280 Clearance - DEEOIC Paper Medical Travel Reimbursement February 2022 - 2-9-2022.docx	02/09/2022

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