Information Collection

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

IC 266504 under ICR 202507-1225-002 · OMB 1225-0093.

Documents and Forms

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

IC Title:

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A				No		Paper Only
Instruction					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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement		04/02/2024

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

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