Voluntary Demographic Survey for Office of Workersâ Compensation Programs (OWCP) Claimants
New collection (Request for a new OMB Control Number)
No
Regular
12/20/2023
Requested
Previously Approved
36 Months From Approved
18,077
0
1,506
0
3,127
0
Voluntary Demographic Form
Historically, the Black Lung Program application forms and other claims processing forms have not collected demographic information. The use of this voluntary demographic form will help identify underserved communities and guide language and outreach strategies, thereby strengthening the customer service experience.
Collecting and analyzing demographic data aligns with the following executive orders Executive Orders: Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, signed by President Biden in January 2021; Executive Order 14075, Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals, also signed by President Biden in January 2021; Executive Order 14031, Advancing Equity, Justice, and Opportunity for Asian Americans, Native Hawaiians, and Pacific Islanders, signed in May 2021; and Executive Order 14058, Transforming Federal Customer Experience and Service Delivery to Rebuild Trust in Government, signed in December 2021.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CM-411 Voluntary Demographic Survey for Office of Workers' Compensation Programs (OWCP) Claimants
Supporting Statement Voluntary Demographic DCMWC_MN_NMH-MM-12-01-23.docx
Voluntary Demographic Survey for Office of Workers' Compensation Programs (OWCP) Claimants