OWCP 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
OWCP Paper Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC)from Authorized Representatives Form and Instruction
Authorized Representative Survey Authorized Representative Survey 12-13-23.pdf Form and Instruction
Authorized Representative Survey Authorized Representative Survey 12-13-23.pdf Form and Instruction
ICR _A11 Section 280 Clearance - DEEOIC Authorized Rep December 2023.docx Authorized Representative Survey Supporting Statement IC Document
ICR _A11 Section 280 Clearance - DEEOIC Authorized Rep December 2023.docx Authorized Representative Survey Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	OWCP 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	N/A	Authorized Representative Survey	Authorized Representative Survey 12-13-23.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 %

	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
Authorized Representative Survey Supporting Statement	ICR _A11 Section 280 Clearance - DEEOIC Authorized Rep December 2023.docx	12/19/2023

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