Medical Travel Reimbursement Survey
Improving Customer Experience (OMB Circular A-11, Section 280 Implementation) for the Department of Labor (DOL)
Medical Travel Reimbursement Survey and Cover Letter
OMB: 1225-0093
U.S.
Department
of
Labor Office
of
Workers’
Compensation
Programs
Division of Energy Employees Occupational Illness Compensation 200 Constitution Ave, NW, Room C-3321
Washington, D.C. 20210
Dear Claimant,
Our records indicate that you recently received medical travel reimbursement from the Division of Energy Employees Occupational Illness Compensation (DEEOIC). As a valued participant in this program, we are very interested in receiving feedback on your experience with DEEOIC.
This survey is focused on gathering feedback reflecting on your experience and interactions as part of the program, specifically about the process leading to the medical travel reimbursement. Your participation in the enclosed customer experience survey will help us identify ways to improve the experience for you and other claimants like you.
The following survey is confidential, and we appreciate your assistance in helping us determine what is working and what may be improved.
Please return this survey using the enclosed postage paid envelope by November 11, 2024.
Thank you for your participation.
Stakeholder Engagement
Branch of Outreach and Technical Assistance
Division of Energy Employees Occupational Illness Compensation
OMB Control Number: 1225-0093
Expiration Date: 1/31/2027
U.S.
Department
of
Labor Office
of
Workers’
Compensation
Programs
Division of Energy Employees Occupational Illness Compensation 200 Constitution Ave, NW, Room C-3321
Washington, D.C. 20210
DEEOIC CUSTOMER EXPERIENCE SURVEY
The OMB control number for this collection is 1225-0093 and expires on 01/31/2027. According to the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information unless such collection displays a valid OMB control number. The obligation to respond to this collection is voluntary. We estimate it takes about 5 minutes to complete this collection of information, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing the collection of infor- mation. Please send comments regarding the burden estimate or any other aspect of this collection of information to the U.S. Department of Labor, DEEOIC, 200 Constitution Ave., NW, Room C-3321, Washington, D.C. 20210 and reference OMB Control Number 1225-0093. Note: Please do not return the completed form to this address.
Please
indicate
your
answers
to
the
statements
below
by
circling a response.
Strongly
Agree
Agree
Neutral
Disagree
Strongly
Disagree
N/A
Based
on
my
experience
submitting
and
receiving
medical
travel
reimbursement, I trust DEEOIC to fulfill our country’s commitment
to
nuclear
workers
and
their
families.
5
4
3
2
1
N/A
What
factors
contributed
to
your
trust
rating?
(You
may
select
more
than
one) Helpfulness/commitment
level
of
employees Expectations/information
provided
throughout
process Ability
to
get
my
needs
addressed Length
of
time
of
process Ease
of
process Fairness
during
process
I
am
satisfied
with
the
service
I
have
received
from
DEEOIC.
5
4
3
2
1
N/A
I
understood
what
I
needed
to
provide
for
travel
reimbursement.
5
4
3
2
1
N/A
The
travel
reimbursement
process
is
moving
at
a
reasonable
pace.
5
4
3
2
1
N/A
It
was
easy
to
complete
what
I
needed
to
do
to
receive
travel
reimbursement.
5
4
3
2
1
N/A
My
travel
reimbursement
questions
were
answered
throughout the
process.
5
4
3
2
1
N/A
The
DEEOIC
employees
I
have
interacted
with
were
helpful.
5
4
3
2
1
N/A
What
resources
have
you
found
most
useful
in
helping
to
under-
stand the program and process?
DEEOIC
website
Resource
Center Employees
Claims
Examiners
Outreach
Events (webinar or
in-person)
Other:
The
amount
I
was
reimbursed
for
medical
travel
was
the
amount
I expected
to receive.
Yes
No
N/A
OMB Control Number: 1225-0093
When submitting your most recent medical travel reimbursement, what parts of the process were easiest to understand or complete? What parts were difficult or confusing? |
|
Easy to Understand |
Difficult to Understand |
Would you like to speak with our Customer Experience Team regarding your experience? Yes No
EQUITY ASSESSMENT
If yes, please provide your name:
and telephone number:
Creating equity in our program means recognizing that different people have different circumstances. Some people face conditions and circumstances that make it more difficult to achieve the same goals. “Equity data” describes aspects of your personal identity. DEEOIC does not collect this type of data, however we want to know if you feel like your own personal circumstances have made it difficult for you to navigate this program. DEEOIC is committed to finding ways to focus on equity for all, including people who have been historically marginalized or adversely affected by inequality. We strive to best serve all our customers, including racial and ethnic mi- norities, persons with disabilities, LGBTQ+ community, rural communities, and other underserved populations. We want to improve program accessibility and inclusion.
Keeping
the
above
information
in
mind,
please indicate if you’ve experienced challenges
with
our
program
because
of
your:
Ability
or
disability
status
Racial
or
ethnic
identity
Age
Sex/Gender
identity
Sexual
orientation
Veteran
status
Religion
Social
class
Geographic
location
(rural/remote)
Other
Based
on
your
selection(s)
to
the
left,
how
can
DEEOIC
better
address
your specific needs?
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | eackerma |
| File Modified | 0000-00-00 |
| File Created | 2025-08-25 |
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