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Federal Black Lung Program Customer Experience Survey
Improving Customer Experience (OMB Circular A-11, Section 280 Implementation) for the Department of Labor (DOL)
OMB: 1225-0093
IC ID: 255161
OMB.report
DOL/DM
OMB 1225-0093
ICR 202312-1225-004
IC 255161
( )
Documents and Forms
Document Name
Document Type
Federal Black Lung Program Customer Experience Survey
Form
Black Lung Survey Instructions.docx
Instruction
Black Lung Survey Instructions.docx
Instruction
Federal Black Lung Program Customer Experience Survey
Customer Experience Survey FINAL 8-2-2022.docx
Form
Federal Black Lung Program Customer Experience Survey
Customer Experience Survey FINAL 8-2-2022.docx
Form
1225-0093 - A11 Section 280 Clearance - Black Lung 8-4-22.docx
Federal Black Lung Program Customer Experience Survey - Supporting Statement
IC Document
1225-0093 - A11 Section 280 Clearance - Black Lung 8-4-22.docx
Federal Black Lung Program Customer Experience Survey - Supporting Statement
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Federal Black Lung Program Customer Experience Survey
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
NA
Federal Black Lung Program Customer Experience Survey
Customer Experience Survey FINAL 8-2-2022.docx
No
Paper Only
Instruction
Black Lung Survey Instructions.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
Unemployment Compensation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
500
0
0
0
0
500
Annual IC Time Burden (Hours)
83
0
0
0
0
83
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Federal Black Lung Program Customer Experience Survey - Supporting Statement
1225-0093 - A11 Section 280 Clearance - Black Lung 8-4-22.docx
08/04/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.