OWCP_ Customer Experience Survey for feedback on claimants with a pending claim

Improving Customer Experience (OMB Circular A-11, Section 280 Implementation) for the Department of Labor (DOL)

Documents and Forms

Document Name Document Type
OWCP_ Customer Experience Survey for feedback on claimants with a pending claim Form
Black Lung Survey- Pending Claim - Instructions 4-1-2024.docx Instruction
CX Survey - Claimants with a Pending Claim 4-1-2024 CX Survey-Claimants with a Pending Claim 4-1-2024.docx Form
DCMWC - ICR _A11 Section 280 Clearance -Recently received a decision 4-1-2024.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	OWCP_ Customer Experience Survey for feedback on claimants with a pending claim	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	N/A	CX Survey - Claimants with a Pending Claim 4-1-2024	CX Survey-Claimants with a Pending Claim 4-1-2024.docx		No		Paper Only
Instruction			Black Lung Survey- Pending Claim - Instructions 4-1-2024.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 %

	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
Supporting Statement	DCMWC - ICR _A11 Section 280 Clearance -Recently received a decision 4-1-2024.docx	04/02/2024

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