Customer Experience Survey for Feedback on Claimants Who have Refiled Claims since Updated Application Forms

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

Documents and Forms

Document Name Document Type
Customer Experience Survey for Feedback on Claimants Who have Refiled Claims since Updated Application Forms Form
Black Lung Survey- Pending Claim - Instructions Final.docx Instruction
CX Survey - Claimants Refiled After Form Updates CX Survey-Claimants Refiled After Form Updates 5-16-2024.docx Form
DCMWC - ICR _A11 Section 280 Clearance -Survey to refiled Claimants since form updates_MN clean.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Customer Experience Survey for Feedback on Claimants Who have Refiled Claims since Updated Application Forms	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 Refiled After Form Updates	CX Survey-Claimants Refiled After Form Updates 5-16-2024.docx		No		Paper Only
Instruction			Black Lung Survey- Pending Claim - Instructions Final.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 -Survey to refiled Claimants since form updates_MN clean.docx	05/16/2024

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