OWCP_Paper Survey for Soliciting Feedback for DEEOIC from claimants who recently received medical travel reimbursement

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

Documents and Forms

Document Name Document Type
OWCP_Paper Survey for Soliciting Feedback for DEEOIC from claimants who recently received medical travel reimbursement Form and Instruction
Medical Travel Reimbursement Survey Medical Travel Reimbursement Survey and Cover Letter.docx Form and Instruction
ICR A11 Section 280 Clearance - DEEOIC Paper Survey Travel Reimbursement_MN_clean.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	OWCP_Paper Survey for Soliciting Feedback for DEEOIC from claimants who recently received medical travel reimbursement	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 and Instruction	N/A	Medical Travel Reimbursement Survey	Medical Travel Reimbursement Survey and Cover Letter.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: 2,000	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	2,000	2,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	ICR A11 Section 280 Clearance - DEEOIC Paper Survey Travel Reimbursement_MN_clean.docx	09/05/2024

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