OWCP Federal Black Lung Program Customer Experience Survey

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

Documents and Forms

Document Name Document Type
Form BL-CX-01 OWCP Federal Black Lung Program Customer Experience Survey Form
Black Lung Survey Instructions.docx Instruction
BL-CX-01 OWCP Federal Black Lung Program Customer Experience Surv BL CX Survey - 7-2-2025 1225-0093.docx Form
DCMWC - ICR _A11 Section 280 Clearance -BL - CX Survey 1225-0093.docx Federal Black Lung Program Customer Experience Survey - Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	OWCP Federal Black Lung Program Customer Experience Survey	Agency IC Tracking Number:

IC Status: Modified

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	BL-CX-01	OWCP Federal Black Lung Program Customer Experience Survey	BL CX Survey - 7-2-2025 1225-0093.docx		No		Paper Only
Instruction			Black Lung Survey Instructions.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,500	1,000	500
Annual IC Time Burden (Hours)	125	42	83
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Federal Black Lung Program Customer Experience Survey - Supporting Statement	DCMWC - ICR _A11 Section 280 Clearance -BL - CX Survey 1225-0093.docx	07/10/2025

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