Development Letter Survey

U.S. Department of Labor

Office of Workers’ Compensation Programs
Division of Energy Employees Occupational Illness Compensation
200 Constitution Ave, NW, Room C-3321
Washington, D.C. 20210

DEEOIC CUSTOMER EXPERIENCE SURVEY
The OMB control number for this collection is 1225-0093 and expires on 01/31/2027. According to the Paperwork Reduction Act of 1995, no person is required to respond to a collection
of information unless such collection displays a valid OMB control number. The obligation to respond to this collection is voluntary. We estimate it takes about 5 minutes to complete this
collection of information, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing the collection of information. Please send comments regarding the burden estimate or any other aspect of this collection of information to the U.S. Department of Labor, DEEOIC, 200 Constitution Ave., NW,
Room C-3321, Washington, D.C. 20210 and reference OMB Control Number 1225-0093. Note: Please do not return the completed form to this address.

Please indicate your answers to the statements below by
circling a response.
Based on the process leading up to receiving the letter requesting
additional evidence/documentation, I trust DEEOIC to fulfill our
country’s commitment to nuclear workers and their families.

Strongly
Agree

Agree

Neutral

Disagree

Strongly
Disagree

N/A

5

4

3

2

1

N/A

What factors contributed to your trust rating? (You may select more than one)

Helpfulness/commitment level of employees
 Ability to get my needs addressed
Expectations/information provided throughout process
Length of time of process

Ease of process
Fairness during process

I am satisfied with the service I have received from DEEOIC.

5

4

3

2

1

N/A

I understood what was being asked of me in the letter.

5

4

3

2

1

N/A

The claims process is moving at a reasonable pace.

5

4

3

2

1

N/A

It was easy to complete what I needed to do to receive the
request for additional evidence/documentation.

5

4

3

2

1

N/A

I have been able to get my questions answered.

5

4

3

2

1

N/A

The DEEOIC employees I have interacted with were helpful.

5

4

3

2

1

N/A

I have been informed of or have access to resources that indicate
the length of time each step in the claims process takes.

5

4

3

2

1

N/A

What resources have you found most useful in helping to understand the program and process?  

Over

Center
DEEOIC website Resource
Employees

Claims
Examiners

Outreach Events
(webinar or Other: _______________
in-person)
OMB Control Number: 1225-0093

Do you have additional feedback related to your experience?

Would you like to speak with our Customer Experience Team
regarding your experience?
Yes 
No 

If yes, please provide your name: ____________________________
and telephone number: ____________________________________

EQUITY ASSESSMENT
Creating equity in our program means recognizing that different people have different circumstances. Some people face conditions and circumstances that make it
more difficult to achieve the same goals. “Equity data” describes aspects of your personal identity. DEEOIC does not collect this type of data, however we want to know
if you feel like your own personal circumstances have made it difficult for you to navigate this program. DEEOIC is committed to finding ways to focus on equity for all,
including people who have been historically marginalized or adversely affected by inequality. We strive to best serve all our customers, including racial and ethnic minorities, persons with disabilities, LGBTQ+ community, rural communities, and other underserved populations. We want to improve program accessibility and inclusion.

Keeping the above information in mind,
please indicate if you’ve experienced
challenges with our program because of your:

Ability or disability status
Racial or ethnic identity
Age
Sex/Gender identity
Sexual orientation
Veteran status
Religion
Social class
Geographic location (rural/remote)
Other________________

Based on your selection(s) to the left, how can DEEOIC better address
your specific needs?


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








The OMB control number for this collection is 1225-0093 and expires on 01/31/2027. According to the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information
unless such collection displays a valid OMB control number. The obligation to respond to this collection is voluntary. We estimate it takes about 6 minutes to complete this collection of information, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing the collection of information. Please send comments regarding the
burden estimate or any other aspect of this collection of information to the U.S. Department of Labor, DEEOIC, 200 Constitution Ave., NW, Room C-3510, Washington, D.C. 20210 and reference OMB
Control Number 1225-0093. Note: Please do not return the completed form to this address.