Information Collection

OWCP -- Survey for Customers Who Recently Received a Decision

IC 264862 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⚠️ Notice: This information collection may be referencing outdated material.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
OWCP -- Survey for Customers Who Recently Received a Decision Form
Black Lung Survey Instructions- Claimants who recently received a decision.docx Instruction
Black Lung Survey Instructions- Claimants who recently received a decision.docx Instruction
CX Survey - Claimants who recently received a decision CX Survey - Claimants who recently received a decision.docx Form
CX Survey - Claimants who recently received a decision CX Survey - Claimants who recently received a decision.docx Form
DCMWC - ICR _A11 Section 280 Clearance -Recently received a decision.docx Supporting Statement IC Document
DCMWC - ICR _A11 Section 280 Clearance -Recently received a decision.docx Supporting Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	OWCP -- Survey for Customers Who Recently Received a Decision	Agency IC Tracking Number:

IC Status: Removed

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	N/A	CX Survey - Claimants who recently received a decision	CX Survey - Claimants who recently received a decision.docx		No		Paper Only
Instruction			Black Lung Survey Instructions- Claimants who recently received a decision.docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

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 %

	Program Change Due to Agency Discretion	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
Supporting Statement	DCMWC - ICR _A11 Section 280 Clearance -Recently received a decision.docx	02/01/2024

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