Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives

Improving Customer Experience (OMB Circular A-11, Section 280 Implementation) for the Department of Labor (DOL)

Documents and Forms

Document Name Document Type
Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives Form and Instruction
DEEOIC Authorized Representative Survey DEEOIC Authorized Representative Survey.pdf Form and Instruction
DEEOIC Authorized Representative Survey DEEOIC Authorized Representative Survey.pdf Form and Instruction
ICR A11 Section 280 Clearance - DEEOIC Paper Survey Authorized Representative May 2022.docx 1225-0093 Supplementary Supporting Statement - DEEOIC Paper Survey Authorized Representative May 2022 IC Document
ICR A11 Section 280 Clearance - DEEOIC Paper Survey Authorized Representative May 2022.docx 1225-0093 Supplementary Supporting Statement - DEEOIC Paper Survey Authorized Representative May 2022 IC Document

Information Collection (IC) Details

IC Title:	Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	DEEOIC Authorized Representative Survey	DEEOIC Authorized Representative Survey.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

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 %

	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

Title	Document	Date Uploaded
1225-0093 Supplementary Supporting Statement - DEEOIC Paper Survey Authorized Representative May 2022	ICR A11 Section 280 Clearance - DEEOIC Paper Survey Authorized Representative May 2022.docx	05/23/2022

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