Information Collection

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

IC 260125 under ICR 202503-1225-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.