OWCP Medical Bill Processing Questionnaire

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

OMB: 1225-0093

IC ID: 263803

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

OWCP Medical Bill Processing Questionnaire
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction N/A OWCP Medical Bill Processing Questionnaire OWCP Medical Bill Processing Questionnaire_12.5.2023_Clean Copy.docx https://forms.office.com/r/QETPjc43mu Yes Yes Fillable Fileable

Health Illness Prevention

 

150 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 150 0 0 0 0 150
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
A-11 Section 280 Coversheet ICR Template_A11 Section 280 Clearance - OWCP MBP Questionnaire_12.5.2023.docx 12/05/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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