Information Collection

Customer Experience Survey for Claimants who are Attending Black Lung Outreach Events

IC 260125 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⚠️ Notice: This information collection may be referencing outdated material.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
Customer Experience Survey for Claimants who are Attending Black Lung Outreach Events	Form
Customer Experience Survey for Claimants who are Attendi Outreach Survey 5-8-2023 FINAL.docx	Form
Customer Experience Survey for Claimants who are Attendi Outreach Survey 5-8-2023 FINAL.docx	Form
1225-0093 - A11 Section 280 Clearance - Black Lung - Outreach Survey.docx Black Lung - Outreach Survey - Customer Experience Survey for claimants who are attending Black Lung Outreach Events	IC Document
1225-0093 - A11 Section 280 Clearance - Black Lung - Outreach Survey.docx Black Lung - Outreach Survey - Customer Experience Survey for claimants who are attending Black Lung Outreach Events	IC Document

IC Title:

Customer Experience Survey for Claimants who are Attending Black Lung Outreach Events

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	NA	Customer Experience Survey for Claimants who are Attending Black Lung Outreach Events	Outreach Survey 5-8-2023 FINAL.docx		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Black Lung - Outreach Survey - Customer Experience Survey for claimants who are attending Black Lung Outreach Events	1225-0093 - A11 Section 280 Clearance - Black Lung - Outreach Survey.docx	05/09/2023

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