OWCP Claimant Access to Care Survey

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

Documents and Forms

Document Name Document Type
OWCP Claimant Access to Care Survey Form
OWCP Provider Access Survey Simple CX Provider Access Survey_Final 11.19.24.docx usdol.gov1.qualtrics.com/jfe/form/SV_eRHpzxnXdL7qivI Form
Email Invitation Language_Claimant Access to Care Survey_11.19.24.docx E-mail Invitation IC Document
ICR_Claimant Access to Care_11.19.24.docx Supplemental Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	OWCP Claimant Access to Care Survey	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	OWCP Provider Access Survey	Simple CX Provider Access Survey_Final 11.19.24.docx	https://usdol.gov1.qualtrics.com/jfe/form/SV_eRHpzxnXdL7qivI	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 653	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-653	653
Annual IC Time Burden (Hours)	-54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
E-mail Invitation	Email Invitation Language_Claimant Access to Care Survey_11.19.24.docx	11/25/2024
Supplemental Supporting Statement	ICR_Claimant Access to Care_11.19.24.docx	11/25/2024

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