Information Collection

OWCP Customer Experience Survey for claimants who are attending Black Lung Outreach events

IC 265531 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
OWCP Customer Experience Survey for claimants who are attending Black Lung Outreach events	Form and Instruction
Outreach Survey OWCP Customer Experience Survey for claimants who are attending Black Lung Outreach events	Form and Instruction
Outreach Survey Outreach Survey 2-20-24.docx	Form and Instruction
Outreach Survey Outreach Survey 2-20-24.docx	Form and Instruction
DCMWC - ICR _A11 Section 280 Clearance -Outreach survey.docx Supporting Statement	IC Document
DCMWC - ICR _A11 Section 280 Clearance -Outreach survey.docx Supporting Statement	IC Document

IC Title:

OWCP 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 and Instruction	N/A				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 %

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
Supporting Statement		02/21/2024

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

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