Customer Satisfaction Survey

OMB Approval #1625-0080
Expiration Date:

USCG Merchant Mariner Licensing and Documentation (MLD) Program

Your Opinion Matters!
THE USCG IS COMMITTED TO PROVIDING YOU WITH EXCELLENT SERVICE. PLEASE HELP US IMPROVE OUR PROCESSES BY COMMENTING ON THE
SERVICES YOU RECEIVED. YOUR FEEDBACK WILL BE USED TO GUIDE OUR EFFORTS TO IMPROVE OUR SERVICES AND PROCESSES. ALL
INFORMATION WILL BE KEPT CONFIDENTIAL.

PLEASE PLACE THE SURVEY IN THE RESPONSE BOX OR MAIL TO OUR CONTACT ADDRESS BELOW.

(OPTIONAL INFORMATION)

YOUR NAME: _____________________________________
CONTACT PHONE NUMBER/EMAIL: ________________________

DATE: _______________
ZIP CODE: _____________

PLEASE DESCRIBE THE NATURE OF YOUR BUSINESS WITH THE USCG (PLEASE CHECK ALL THAT APPLY):
METHOD
LOCATION
CREDENTIAL
TRANSACTION TYPE
( ) IN PERSON
( ) REGIONAL EXAM
( ) LICENSE
( ) ORIGINAL
CENTER:
( ) RENEWAL
( ) BY TELEPHONE
( ) STCW CERTIFICATE
__________________
( ) DUPLICATE
( ) NATIONAL MARITIME
( ) MERCHANT MARINERS
( ) BY MAIL
( ) RAISE IN GRADE
CTR, ARLINGTON, VA
DOCUMENT
( ) OTHER:
( ) CERTIFICATE OF
( ) BY EMAIL
( ) CHANGE IN SCOPE
____________________
REGISTRY
( ) WEBSITE
( ) ENDORSEMENT
WHY DID YOU CHOOSE THIS LOCATION? (PLEASE CHECK ALL THAT APPLY)
( ) PROFESSIONALISM OF SERVICE
( ) CLOSEST TO MY LOCATION
( ) OTHER (PLEASE COMMENT BELOW)
( ) MY FILE IS LOCATED HERE

SERVICE
( ) GENERAL INFO
( ) APPLICATION
PKG.
( ) EVALUATION
( ) TESTING
( ) ISSUANCE

( ) SPEED OF SERVICE

PLEASE INDICATE YOUR AGREEMENT WITH THE STATEMENTS BELOW AS FOLLOWS:
(IF THE STATEMENT IS “NOT APPLICABLE”, PLEASE WRITE “N/A”.)
STRONGLY AGREE
10
9

8

MODERATELY AGREE
7
6

MODERATELY DISAGREE
5
4

3

STRONGLY DISAGREE
2
1
RESPONSE

STATEMENT
• I FEEL THAT THE SERVICE RECEIVED FULLY SATISFIED MY NEEDS
• I WOULD RECOMMEND THIS LOCATION TO ANOTHER MARINER
• THE NMC WEBSITE OR LOCAL REC WEBSITE PROVIDED ANSWERS TO MY QUESTIONS
• THE INFORMATION PACKETS AND FORMS WERE EASY TO USE
• THE TIME TO PROCESS MY APPLICATION WAS WITHIN THE STATED PROCESSING PERIOD
• THE STAFF WAS KNOWLEDGEABLE AND PROFESSIONAL
• SOMEONE WAS ABLE TO ANSWER MY QUESTIONS
• I WAS ABLE TO REACH A CLERK, EVALUATOR, EXAMINER, OR SUPERVISOR, AS NECESSARY
• THE FACILITIES WERE CLEAN AND ADEQUATE AND MET MY NEEDS
• THE EXAMINATIONS WERE APPROPRIATE FOR THE CREDENTIALS I NEEDED
• THE USCG APPROVED COURSES WERE APPROPRIATE FOR THE CREDENTIALS I NEEDED
WOULD YOU LIKE SOMEONE TO CONTACT YOU (HAVE YOU INCLUDED YOUR CONTACT DETAILS)?

( ) YES ( ) NO
PLEASE HELP US BY PROVIDING WRITTEN EXPLANATIONS ON THE BACKSIDE OF THIS SHEET. WE ALSO WELCOME OTHER IMPROVEMENT SUGGESTIONS AND
COMPLIMENTS TO OUR TEAM.
PLEASE RETURN COMPLETED OPINION FORMS TO ONE OF OUR TEAM OR SEND IT TO:

THANK YOU!

Thank You!
MLD-FM-REC-08(3)

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The Coast Guard estimates that the
average burden for this form is 10 minutes. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commandant (G-PCQ ),
U.S. Coast Guard, Washington, DC 20593-0001 or Office of Management and Budget, Paperwork Reduction Project (1625-0080), Washington, DC 20503"