Information Collection

OWCP Claimant Access to Care Survey

IC 272642 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⚠️ Notice: This information collection may be referencing outdated material.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

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
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
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
ICR_Claimant Access to Care_11.19.24.docx Supplemental Supporting Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

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.