Technical Fourm/Workshop Evaluation

TECHNICAL FORUM/WORKSHOP EVALUATION

OMB # 1029-0114

Expires 2/29/2008

The Office of Surface Mining (OSM) conducted a forum/workshop identified below. OSM would appreciate you taking the time to complete this evaluation. Your response will assist us in evaluating and improving our performance. We are collecting this information as a part of evaluating OSM’s performance of its responsibilities under the Government Performance and Results Act. Your response is voluntary and confidential.

EVENT TITLE -

EVENT DATE -

Please rate “usefulness” of each speaker’s subject matter. Rate as (1) Poor, (2) Fair, (3) Good, (4) Excellent,

Speaker 1 _______ Speaker 2 _______ Speaker 3 _______ Speaker 4 ________ Speaker 5 _______

Which topic sessions were the most useful to you?

Were there additional topics or speakers that should have been included?

Do you have topic suggestions for future interactive forums/workshops?

How could the format of future forums/workshops be improved?

Please rate your level of satisfaction with the forum/workshop.

(Please circle one)

(very dissatisfied) 1 2 3 4 5 (very satisfied)

Please rate the facilities and accommodations.

(Please circle one)

(poor) 1 2 3 4 5 (excellent)

Other comments or suggestions?

Return this evaluation form to your forum host or

Send to: Office of Surface Mining or Fax to: 618-464-6470

501 Belle Street

Alton, IL 62002

PAPERWORK REDUCTION STATEMENT

The Paperwork Reduction Act of 1995 (44 U.S.C. 3501) requires us to inform you that: Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. This information is being collected in order to better serve you in the future and as part of OSM's performance of its responsibilities under the Government Performance and Results Act. The obligation to respond is voluntary.

Public reporting burden for this form is estimated to average 5 minutes per response, including time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, Room 202 SIB, 1951 Constitution Ave, NW, Washington, D.C. 20240.