Customer Satisfaction Survey from 1660-0036

PROGRAM EFFECTIVENESS AND RECOVERY SURVEY OMB Control No. 1660-0036

(March 14, 2007)

Hello, I’m calling on behalf of FEMA, the Federal Emergency Management Agency. My name is _____. May I please speak with ____________________(applicant name)?

If no: Is there a better time tonight when I may call back? If no, document the Attempt Field as “Call Back”, add a Comment with a time to call tonight: Thank you for your time and have a nice evening.

If yes: You recently had an application for disaster assistance processed by FEMA related to ________________ (name of disaster). Are you the one who handled your case?

If no, ask: Is that person available? And may I ask their name?

If no: Is there a better time tonight when I may call back? If yes, document the Attempt Field as “Call Back”, add a Comment with a time to call tonight: Thank you for your time and have a nice evening.

If yes: (Applicant name), we’re looking for ways to improve the quality of our service based on your opinions. Could you take 10-15 minutes to answer some questions right now?

If yes: Good. The following questions have been approved by the Office of Management and Budget under number 1660-0036. Please be assured your responses are voluntary and will in no way affect the outcome of your application for FEMA assistance.

If no, document the Attempt Field as “Decline”: Okay. Thank you for your time and have a nice evening.

KEY RATING QUESTION
All right, (Applicant’s name), we’ll start with a very general question about the assistance you received.
Question		Response Options
Overall, how would you rate the information and support you received from FEMA since the disaster occurred? Would you say it’s been………………………….. (READ list) (If “Below average” or “Poor”, go to Q.1a, otherwise skip to Q.2)		Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
1a. In what way was the information and support [Below average / poor ]? (DO NOT read list)		Did not receive enough / financial assistance Application process too complicated Information inconsistent or wrong programs not explained clearly Dissatisfaction with Inspection Took too long to get assistance Poor customer service Other (Put specific response in comments box)

Housing Assistance or Other Needs Assistance questions will auto-populate if NEMIS indicates respondent has received assistance for either program. Respondents who did not receive assistance for either program will skip to Q14.
Other Needs Assistance Program Skip to Q.3	Housing Assistance Program Go to Q.2	Non-eligible for HL or ONA Skip to Q.14

HOUSING ASSISTANCE PROGRAM
Question		Response Options
This next series of questions refers to FEMA’s Housing Assistance Program.
2. Following the disaster, was FEMA able to assist you with the repairs to your home or provide rental assistance? (DO NOT read list) (If “No”, go to Q.2a, otherwise skip to Q.2b)			Yes No Don’t Know / No Opinion
2a. Why was FEMA unable to provide assistance? (DO NOT read list. Mark all that apply.) (If ONA, skip to Q3, otherwise skip to Q4)			Insurance covered loses Inspection did not consider everything Case still pending Didn’t qualify for FEMA assistance Do not know why Other (Put specific response in comments box)
2b. Considering your losses, how would you rate the assistance you received from FEMA to meet your housing needs? Would you say it was …. (READ list) (If “Below average” or “Poor” go to Q.2c; if ONA skip to Q.3, otherwise skip to Q.4)			Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
2c. How was the assistance you received Below Average / Poor)? (DO NOT read list)			Dissatisfaction with Inspection Not enough money awarded Didn’t qualify for FEMA assistance Took too long Guidelines unfair Other (Put specific response in comments box)

TIMELINESS OF HA ASSISTANCE
2d. From the time you applied for disaster assistance until you actually received assistance from FEMA, how would you rate the length of time it took? Would you say it was…. (READ list) (If “Below average” / “poor”, go to Q4a, otherwise skip to Q. 5.)	Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
2e. Why do you feel the length of time to was not appropriate? (DO NOT read list. Mark all that apply.)	Delayed due to Appeal process Process took too long Incorrect information on application More than one inspection Delayed by insurance company Other (Put specific response in comments box)

OTHER NEEDS ASSISTANCE PROGRAM
Question		Response Options
This next series of questions refers to the “Other Needs Assistance Program” funded by the State of __________. This program may have assisted you with damages to your vehicle, clothing household items, with a generator or other uninsured expenses.
3. After the disaster, was this Program able to help you with any of the losses I just mentioned ? (DO NOT read list) (If “No”, go to Q.3a, otherwise skip to Q.3b)			Yes No Don’t Know / No Opinion
3a. Why not? (DO NOT read list) (Skip to Q4)			Do not know why Inspection didn’t consider everything Insurance covered loses Didn’t qualify for ONA assistance Case still pending Other (Put specific response in comments box)
3b. Considering your losses, how would you rate the assistance you received from this Program to meet those needs? Would you say it was …. (READ list) (If “Below average” or “Poor”, go to Q.3c, otherwise skip to Q.4)			Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
3c. In what way was the assistance you received ( Below Average / Poor)? (DO NOT read list)			Didn’t receive enough assistance/money Inspector didn’t consider everything Didn’t qualify for ONA assistance Took too long to receive assistance Guidelines unfair Other (Put specific response in comments box)

TIMELINESS OF ONA ASSISTANCE
4. From the time you applied until you actually received assistance from the Other Needs Program, how would you rate the length of time it took? Would you say it was…. (READ list) (If “Below average” / “poor”, go to Q4a, otherwise skip to Q. 5.)	Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
4a. Why do you feel the length of time to receive assistance was not appropriate? (DO NOT read list. Mark all that apply.)	Delayed due to appeal process Process took too long Incorrect information on application More than one inspection Delayed by insurance company Other (Put specific response in comments box)

INSPECTION SERIES
AUTO-POPULATE THIS QUESTION ONLY IF RESPONDENT RECEIVED AN INSPECTION.
Question		Response Options
Now, I’d like you to think about the initial inspection FEMA conducted to assess your damages.
I see you had multiple inspections. Which one would you like to be surveyed about? 5a. How many days after your initial call did FEMA conduct the inspection? (If needed, probe with “What’s your closest estimate?”)		[______]Initial inspection [______]Second inspection [_______]
5b. How would you rate the amount of time between your registration and the actual inspection? Would you say it was (READ list)		Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
5c. Overall, how satisfied are you with the inspection FEMA conducted? Would you say you are.. (READ list) (If “Less than” or “Not at all satisfied”, go to 5d, otherwise, skip to Q.6..		Extremely satisfied Very satisfied Satisfied Less than satisfied Not at all satisfied (DO NOT read) Don’t know / No opinion
5d. Why were you dissatisfied with the inspection FEMA conducted? (DO NOT read list)		Did not explain anything to me or answer my questions Did not get my input Did not look at all my damages Not qualified, no financial assistance or not enough Poor Customer Service Did not come at scheduled time Did not take enough time Other (Put specific response in comments box) box)

LEVEL OF RECOVERY
Question			Response Options
And now I’d like to get your feelings about the level of recovery you’ve experienced since the disaster.
6. Would you say you have………….. (READ list)			Completely recovered Somewhat recovered, or Have not begun to recover (DO NOT read) Don’t know / No opinion

FEMA ROLE IN RECOVERY
6a. Thinking about FEMA’s role in your recovery, would you say FEMA’s been ….. (READ list) (If “Not very helpful” / “Not at all helpful”, go to 5b, otherwise go to Q.6)	Extremely helpful Very helpful Somewhat helpful Not very helpful, or Not at all helpful (DO NOT read) Don’t know / No opinion
6b. Why do you feel that way? (DO NOT read list. Mark all that apply.)	Didn’t receive any assistance / money Didn’t receive enough assistance / money Process took too long Guidelines Unfair Other (Put specific response in comments box)

REPUTATION IN COMMUNITY
Question		Response Options
Next, I’d like you to think about the image FEMA has in your community.
Based on what you’ve seen, read, and heard, as well as your personal opinion, how would you rate FEMA’s overall reputation in your community? Would you say it is ………… (READ list) (If “Below average” or “Poor”, go to Q7a, otherwise skip to Q.8.)		Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
7a. What do you think the reason would be? (DO NOT read list. Mark all that apply.)		Application process too complicated No consistency in amount awarded Not enough money awarded Disaster assistance information mis-communicated Did not qualify for assistance Poor Customer Service Took too long to get assistance Other (Put specific response in comments box)

AMERICAN RED CROSS REFERRAL
Question		Response Options
(DO NOT read) American Red Cross Series– only to be asked if the applicant was referred to the American Red Cross.
8. After you registered with FEMA, we may have advised you to contact the American Red Cross. Were you able to contact that agency? (DO NOT read list) (If “No”, go to Q.7a, otherwise skip to Q.7b.)			Yes No
8a. Why were you unable to contact the Red Cross? (DO NOT read list. Mark all that apply.) (Skip to Q8.)			Decided not to Do not remember, do not know why, I forgot Didn’t know how to Didn’t know I was supposed to No longer had a need to Tried, but was unable to reach them Other (Put specific response in comments box)
8b. How would you rate the overall assistance provided by the Red Cross? Would you say it was…………………. (READ list) (If “Below average” or “Poor”, go to Q.7c, otherwise skip to Q.8.)			Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
8c. In what way was the assistance [below average or poor]? (DO NOT read list. Mark all that apply.)			Not enough assistance to meet my needs Agency did not Follow Through Had no programs / funds to assist me Didn’t qualify for assistance Poor customer service Took too long / too confusing Other (Put specific response in comments box)

FARM SERVICES ADMIN REFERRAL
Question		Response Options
(DO NOT read) FARM SERVICES ADMINISTRATION Series – only to be asked if the applicant was referred to Farm Services.
9. After you registered with FEMA, we may have advised you to contact the Farm Services Administration. Were you able to contact that agency? (DO NOT read list) (If “No”, go to Q.8a, otherwise skip to Q.8b.)			Yes No Don’t know / Don’t remember
9a. Why were you unable to contact the Farm Services Administration? (DO NOT read list. Mark all that apply.) (Skip to Q10.)			Decided not to Do not remember, do not know why, I forgot Didn’t know how to Didn’t know I was supposed to No longer had a need to Tried, but was unable to reach them. Other (Put specific response in comments box)
9b. How would you rate the overall assistance provided by Farm Services? Would you say it’s been………. (READ list) (If “Below Average” / “Poor”, go to Q.8c, otherwise skip to Q.9.)			Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know/ No opinion
9c. In what way was it [below average or poor]? (DO NOT read list. Mark all that apply.)			Agency had no funds Agency did not follow through Case still pending Took too long / too confusing Agency had no program Didn’t qualify for assistance Poor customer service Other (Put specific response in comments box)

DISASTER UNEMPLOYMENT REFERRAL
Question			Response Options
(DO NOT read) DISASTER UNEMPLOYMENT Series– only asked if applicant was referred to Disaster Unemployment.
10. After you registered with FEMA, we may have advised you to contact the Unemployment Agency. Were you able to contact that agency? (DO NOT read list) (If “No”, go to Q.9a, otherwise skip to Q.9b.)		Yes No
10a. Why were you unable to contact the Unemployment agency? (DO NOT read list. Mark all that apply.) (Skip to Q10.)		Decided not to Do not remember, do not know why, I forgot Not unemployed, not qualified, self-employed Didn’t know I was supposed to No longer had a need to Tried, but unable to reach them. Other (Put specific response in comments box)
10b. Was the Unemployment Agency able to assist? (DO NOT read list) (If “No”, go to Q.9c, otherwise skip to Q.10.)		Yes No Case still pending
10c. Why was the Unemployment Agency unable to provide you with assistance? (DO NOT read list. Mark all that apply.)		Not enough help to meet needs Didn't submit the paperwork Agency had no program / funds to assist Didn’t qualify for assistance Other (Put specific response in comments box)

INTERNAL REVENUE SERVICE REFERRAL
Question			Response Options
(DO NOT read) INTERNAL REVENUE SERVICE Series – only to be asked if the applicant was referred to the Internal Revenue.
11. After you registered with FEMA, we may have advised you to contact the Internal Revenue Service. Were you able to contact that agency? (DO NOT read list) (If “No”, go to Q.10a, otherwise skip to Q.10b.)				Yes No
11a. Why not? (DO NOT read list. Mark all that apply.) (Skip to Q11.)	Decided not to Do not remember, do not know why, I forgot Didn’t know how to contact agency or Tried but unable Didn’t know I was supposed to No longer had a need to Too soon, will later or have accountant contact the IRS Other (Put specific response in comments box)
11b. Was the Internal Revenue Service able to offer any assistance? (DO NOT read list) (If “No”, go to Q.10c, otherwise skip to Q.11.)	Yes No Case is still pending
11c. Why was the Internal Revenue Service unable to assist you? (DO NOT read list. Mark all that apply.)	Too complicated Insufficient losses to claim Didn’t submit the paperwork Don’t know why or do not remember Other (Put specific response in comments box)

SMALL BUSINESS ADMIN REFERRAL
Question		Response Options
(DO NOT read) SMALL BUSINESS ADMINISTRATION Series– only to be asked if the applicant was referred to SBA.
12.After you registered with FEMA, we may have advised you to contact the Small Business Administration. This agency might have been able to assist you with a low interest rate loan. Were you able to contact that agency? (DO NOT read list) (If “No”, go to Q.11a, otherwise skip to Q.11b.)			Yes No
12. Why were you unable to contact the Small Business Administration? (DO NOT read list. Mark all that apply.) (Skip to Q12.)			Decided not to Do not remember, do not know why, I forgot Didn’t know how to contact the agency or tried but was unable Didn’t know I was supposed to No longer had a need to Too soon, will later Other (Put specific response in comments box)
12b. How would you rate the overall assistance provided by the Small Business Administration? Would you say it’s been………. (READ list) (If “Below average” or “Poor”, go to Q.11c, otherwise skip to Q.12.)			Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
12c. In what way was the overall assistance [below average or poor]? (DO NOT read list. Mark all that apply.)			Not enough assistance to meet my needs Did not submit paperwork Case still pending Did not want the loan or the terms; too much debt Didn’t qualify for assistance or Agency had not funds Poor customer service Took too long / too complicated Other (Put specific response in comments box)

INSURANCE REFERRAL
Question		Response Options
(DO NOT read) INSURANCE Series – only to be asked if the applicant was referred to their own Insurance Company.
13. After you registered with FEMA, we may have advised you to contact your Insurance Company. Were you able to contact them? (DO NOT read list.) (If “No”, go to Q.12a; if “yes”, skip to 12b.)			Yes No
13a. Why were you unable to contact your insurance company? (DO NOT read list. Mark all that apply.) (Skip to Q12d.)			Didn’t know I was supposed to, didn’t know how or tried but unable Decided not to No longer had a need to Did not have coverage Deductible too high Forgot to Other (Put specific response in comments box)
13b. Were they able to assist you with your needs? (DO NOT read list.) (If “No”, go to Q.12c, otherwise skip to Q.12d.)			Yes No Case is still pending
13c. Why couldn’t your insurance company help you? (DO NOT read list. Mark all that apply.)			Didn't submit the paperwork Didn’t qualify for assistance, No coverage, deductible too high Not enough assistance to help with my needs Other (Put specific response in comments box)

AT END OF REFERRALS: OFFER TO PROVIDE REFERRAL CONTACT INFORMATION FOR ANY AGENCY THAT RESPONDENT WAS INITALLY REFERRED TO BUT DID NOT CONTACT.

LEVEL OF UNDERSTANDING FOR INELIGIBLE
(DO NOT read) These questions are asked only if respondent was not eligible for assistance.
14. How well did you understand the explanation you were given about why you didn’t qualify for assistance from FEMA? Would you say you………….. (READ list) (If “Somewhat understood” or “Did not understand”, go to 14a, otherwise, skip to Q.15.)	Fully understood Somewhat understood, or Did not understand the explanation given Did not agree with the answer (DO NOT read) Don’t know / No opinion
14a. How well did you understand the explanation you were given about why you didn’t qualify for assistance from the State? Would you say you………….. (READ list) (If “Somewhat understood” or “Did not understand”, go to 14a, otherwise, skip to Q.15.)	Fully understood Somewhat understood, or Did not understand the explanation given Did not agree with the answer (DO NOT read) Don’t know / No opinion
14b. Refer applicant to Helpline to provide explanation regarding why they did not quality for assistance.

.

SUGGESTIONS TO IMPROVE
Question		Response Options
(READ) For this next question, FEMA’s interested in getting your opinion on what we could do to improve our service.
15. What suggestions would you like to pass on to FEMA?		Open-ended: Type response in designated area. ­­­­­­­­­­­­­­­­­­­­­­­­_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CUSTOM QUESTIONS: for special usage to benefit planning, program changes, future enhancements, etc.

CUSTOM QUESTIONS – Registration Intake Phone Survey or Helpline Phone Survey Re: On-Line Registration Attempt
Question	Response Options
This question is about the On-Line Internet Registration that applicants may use by going to the Individual Assistance Center on the FEMA.gov website. This allows you to enter your Registration over the internet and is available 24 hours a day 7 days a week.
CQ IAC-Reg#1. Did you attempt to do your own Disaster Assistance Registration over the Internet? If yes go to Question CQ IAC-Reg#1a.	Yes No (DO NOT read) Don’t remember
CQ IAC-Reg#1a. Why were you unable to complete your registration over the Internet? (Do not read list; listen and mark all that apply.)	Did not have compatible browser Unable to access the site or page Information was not helpful General instructions were not clear Specific instructions for entering data were not clear Could not figure out how to navigate FEMA.gov Response time was too slow Could not complete due to technical problems Could not get answer to technical questions from Helpdesk Was not confident that FEMA got registration so also registered over the telephone Difficult to use Not enough information Too much information Took too long Other (Specify)

CUSTOM QUESTIONS – Registration Intake Phone Survey or Helpline Phone Survey Re: Internet Inquiry or Update
Question		Response Options
This question is about the Internet Individual Assistance Center which you may use by going through the FEMA.gov website. This allows you to view your FEMA Registration over the internet and is available 24 hours a day 7 days a week. You may check your eligibility and inspection status, correspondence or make minor changes to insurance or contact information.
CQ IAC-Inq # 1. Did you attempt to use the Individual Assistance Center on the Internet to inquire about your application prior to calling FEMA’s Helpline? If yes go to Question CQHL IAC #1a	Yes No (DO NOT read) Don’t remember
CQ IAC-Inq #1a. Why were you unable to use the Individual Assistance Center Website to inquire into your case?	Did not have compatible browser Unable to access the site or page Information was not helpful General instructions were not clear Specific instructions for entering data were not clear Could not figure out how to navigate Response time was too slow Information I wanted was not on my account Could not get answer to technical questions from Helpdesk Was not confident the changes were made; so called Helpline to verify. Difficult to use Not enough information Too much information Took too long to view / edit my information Other (Specify)

CUSTOM QUESTIONS – Disaster Recovery Center
Question		Response Options
CQDRC#1 (was #3). After the disaster, did you have an opportunity to visit FEMA’s Disaster Recovery Center? (If “YES”, go to CQ.3a, otherwise skip to CQ.3c.)		Yes No None located in my area (DO NOT read) Don’t know / No opinion / Do Not Remember
CQDRC #1a (was #3a). Overall, how would you rate the quality of service you received at that Center? Would you say it was… (READ list) (If “Below average” / “Poor”, go to CQ.3b, otherwise skip to CQ.3c.)		Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
CQDRC #1b (was 3b). Why do you feel the quality of service you received was [below average / poor? What was the location of the Center? _______ (DO NOT read list)		Difficulty finding DRC Staff had poor attitude Staff didn’t treat me with respect Staff didn’t explain programs clearly Staff didn’t take time to listen to me Staff didn’t seem interested in helping me Took too long to get assistance Other (Specify)

CUSTOM QUESTIONS- INTERNET AT CENTRALIZED LOCATION
Question			Response Options
CQI@CL#4 If FEMA were to provide internet access at a centralized location, how likely would you be to go to that location to use the internet and other services provided? (READ list)			Extremely likely Very likely Somewhat likely Not very likely, or Not at all likely (DO NOT read) Don’t know / No opinion
CQI@CL#4-1 Next, I’d like to get your opinion on which types of services you feel would be helpful to you if you went to a centralized location. Using a rating scale of Not Important, Somewhat Important or Very Important, please tell me the level of importance you place on each of the following services: (READ list)
	Type of service	Not important			Somewhat Important	Very Important
CQ.4a. CQ.4b. CQ.4c. CQ.4d. CQ.4e. CQ.4f. CQ.4g CQ.4h CG.4i CQ.4j. CQ.4k	access to disaster assistance program information apply for disaster assistance over the internet learn about documentation you’ll need to apply look up the status of your case make minor corrections to your application access a telephone have E-Mail capability have Faxing capability make copies of needed documents access to a printer What else do you think FEMA should provide at that location?

CUSTOM QUESTIONS – Automated Information System (IVR)
Question	Response Options
Another service FEMA has is an automated information system to let applicants check the status of their application without having to wait to talk to a representative. Although you would not talk directly to a FEMA representative in person, the automated system would provide the ability to check your status in a more convenient way.
(Ask CQIVR#1 only if the information is not available electronically). CQIVR#1. Have you used this method to check the status of your case? (Do not READ list) If no or Do not Remember, go to Next Question.	Yes No Do not Remember
CQIVR#1a. How helpful was the automated system in providing you the information you needed? (READ list) If somewhat, not very, or not at all helpful, ask CQIVR#1c:	Extremely Helpful Very Helpful Somewhat Helpful Not very Helpful Not at all Helpful (DO NOT read) Don’t know / No opinion
CQIVR #1b. Tell me a little about that experience. (Do not Read the list. Mark all that apply.)	Confusing Had to contact the Helpline (record Yes in CQIVR1c) Did not understand the status Not confident the status was accurate Needed additional information Poor sound quality Instructions not clear Instructions too long Could not navigate Could not skip through Had to punch too many numbers Had to start over No way to repeat the needed instruction No way to go back to the beginning Other (record specific reason)

CUSTOM QUESTIONS – Automated Information System (IVR)	continued
For all responses CQIVR#1c. After you used the automated system, did you also talk to a FEMA Helpline Representative? If yes, go to CQIVR#1d	Yes No Do no Remember
CQIVR#1d. Why did you need to talk to the Helpline? (Do not Read the list. Mark all that apply.)	To be sure the IVR message was correct To understand the status To ask what to do next To appeal (or ask how to appeal) To ask what my funds covered To ask when my funds would be received To ask if the funds would come by check or EFT To ask what the letter I received referred to Other (specify)
If CQIVR#1c is Yes: CQIVR#1e. Was the HL representative knowledgeable about the message you heard on the automated information system?	Yes No Do not Remember
CQIVR#1f. Do you have any suggestions to improve this automated system? [If yes, enter the suggestion]

CUSTOM QUESTIONS – Auto Dialer Feature
Another feature FEMA uses to keep you informed is an auto dialer which calls you to let you know that FEMA has received your fax, your letter or your returned mail. It is also used to let you know when we have sent a letter so that you can be expecting it in the mail.
Question	Response Options
(Ask CQAD#1 only if the information is not available electronically). CQAD#1. Did you receive a message from a recording stating your correspondence or fax was received? Or a message explaining you will be receiving a letter from FEMA in the mail? (DO NOT read list) If No or Do Not Remember, go to “Next Question” at the bottom of the screen If yes, go to CQAD#1a	Yes No Do not Remember
(Ask CQAD#1a only if the information is not available electronically). CQAD#1a. What document did the recording refer to? (DO NOT read list. Mark all that apply.) Continue to CQAD#1b if 4-6) selected	1) Fax received at FEMA 2) Correspondence received at FEMA 3) App’s Mail Returned to FEMA 4) FEMA Letter to App - X 5) FEMA Letter to App - Y 6) FEMA Letter to App - Z 7) Do not Remember 8) Other (specify)
If 4) or 5) or 6) from CQAD#1a, ask CQAD#1b. Did you receive the automated message before you received your letter in the mail?	Yes On the same Day No Do not remember
CQAD#1c. How many times did you receive the same message? Was that ____ (number) just right, okay or too many?	_____ number of times Just right Okay Too many

CUSTOM QUESTIONS – Auto Dialer Feature	continued
CQAD#1d. How helpful was that recording? (Read list.) (If Somewhat helpful, Not very helpful or Not at all helpful, go to CQAD#1e)	Extremely helpful Very helpful Somewhat helpful Not very helpful Not at all helpful (do not read) Don’t know/No opinion
CQAD#1e. In what way? (DO NOT read list. Mark all that apply.)	Confusing Not sure which document the recording referred to Did not understand what I was to do next Sound was not clear Received the same message over and over again Message came too late, I already knew about the information Message came at an inappropriate time of day (which was _______ cst on a ____day) Had already called the HL Had to call the HL (record Yes in CQAD#1f) Other (specify)
For all responses from CQAD#1e CQAD#1f. After you heard the recording, did you call the FEMA Helpline? If yes, go to CQAD#1e	Yes No Do not Remember
If CQAD#1f is Yes: CQAD#1g. Why did you call the Helpline? (DO NOT read list. Mark all that apply.)	Clarification of the auto dialer message To hear the auto dialer message repeated To change my address, phone number, etc. To ask what to do next To appeal (or ask how to appeal) To ask what my funds covered To ask what the letter I received referred to Other (specify)

CUSTOM QUESTIONS – Auto Dialer Feature	continued
If CQAD#1f is Yes: CQAD#1h. Was the HL representative knowledgeable about the recorded message you received?	Yes No Do not Remember
CQAD#1g. Do you have any suggestions to improve this recorded message feature? [If yes, enter the suggestion]

CUSTOM QUESTION - SPECIAL NEEDS
Data provided by Special Needs Coordinator when disaster specific needs are identified; such as, over age 60, Special Needs custom questions answered at RI, NEMIS comment “JFO Special Needs” or “JFO SN”, Community Relations, DRC, ISC, EOC or another Agency identifies a need, or the Long Term Recovery Committee has exhausted all resources. At Registration, Applicants are asked: Did you, your spouse or any dependents have help or support doing things like walking, seeing, hearing, or taking care of yourself before the disaster and have you lost that help or support because of the disaster?
This next question is for Applicants who indicated they have additional needs and who have been contacted by a FEMA disaster worker (from the JFO) to help them and to see what assistance is available:
QUESTION			RESPONSE
CQSN#1	Has a FEMA disaster worker contacted you about your needs for help or support doing things like walking, seeing, hearing, or taking care of yourself? If Yes: What was the name of the FEMA person who contacted you?______		Yes No (Use of JFO database will provide this answer. Skip to CQSN#1a)
CQSN#1a	Overall, how would you rate the way the FEMA disaster worker you spoke with handled that contact? Would you say ____/the disaster worker was…		Excellent Good Satisfactory Below Average Poor Do not know/no opinion
CQSN#1b	If Below Average or Poor: In what way was the contact [below average/poor]? (NOTE: Do not read the list, listen and mark all that appl.)		Didn’t receive financial assistance Didn’t receive enough financial assistance Process was too complicated Took too long to receive assistance Rep didn’t seem interested in helping me Rep didn’t take time to listen to me Rep didn’t treat me with respect Rep had poor attitude Rep didn’t explain programs clearly Could not contact the Rep to ask additional questions Other:

CUSTOM QUESTION - SPECIAL NEEDS, continued
QUESTION		RESPONSE
CQSN#1c	How would you rate _____/ (the disaster worker) on clearly explaining the disaster assistance programs and services available to you? Would you say…	Excellent Good Satisfactory Below Average Poor Do not know/no opinion
CQSN#1d	If Below Average or Poor: What programs and services were ___/ (the disaster worker) not able to explain? (NOTE: Do not read the list, listen and mark all that apply.)	Medical Dental Funeral Housing Assistance, specify: Other Needs Assistance, specify: Other:
CQSN#1e	During this contact, were you referred to another agency for assistance? If yes, which one? If no – this concludes the SN questions	________ (Use of JFO database will provide this answer. Skip to CQSN#1f)
CQSN#1f	For the 1st Agency you were referred to for assistance: How would you rate the overall assistance provided by ________ (agency)?	Excellent Good Satisfactory Below Average Poor Do not know/no opinion
CQSN#1g	If Below Average or Poor: In what way was the assistance [below average or poor]?	Didn’t receive financial assistance Didn’t receive enough financial assistance Process was too complicated Took too long to receive assistance Rep was not knowledgeable Rep had poor customer service Other:

CUSTOM QUESTION - SPECIAL NEEDS, continued
QUESTION		RESPONSE
CQSN#1h	For the 2nd Agency you were referred to for assistance: How would you rate the overall assistance provided by ________ (agency)? (Use multiple referral questions as needed.)	Excellent Good Satisfactory Below Average Poor Do not know/no opinion
CQSN#1i	If Below Average or Poor: In what way was the assistance [below average or poor]?	Didn’t receive financial assistance Didn’t receive enough financial assistance Process was too complicated Took too long to receive assistance Rep was not knowledgeable Rep had poor customer service Other:
CQSN#1j	For the 3rd Agency you were referred to for assistance: How would you rate the overall assistance provided by ________ (agency)? (Use multiple referral questions as needed.)	Excellent Good Satisfactory Below Average Poor Do not know/no opinion
CQSN#1k	If Below Average or Poor: In what way was the assistance [below average or poor]?	Didn’t receive financial assistance Didn’t receive enough financial assistance Process was too complicated Took too long to receive assistance Rep was not knowledgeable Rep had poor customer service Other:

CUSTOM QUESTIONS – FUTURE USE
Question		Response Options
CQ future #1. (DO NOT read list)		Yes No Don’t know / No opinion

CUSTOM QUESTIONS – FUTURE USE
Question		Response Options
CQ future #2. (DO NOT read list) .		True False Don’t know / No opinion

CUSTOM QUESTIONS – FUTURE USE
Question		Response Options
CQ future #3. (READ list)		Extremely likely Very likely Somewhat likely Not very likely, or Not at all likely (DO NOT read) Don’t know / No opinion
CQ future #3a. If Not very likely, or Not at all likely: Why not?		X X X X X

CUSTOM QUESTIONS – FUTURE USE
Question		Response Options
CQ future #4. (READ list)		Excellent Good Satisfactory Below average, or Poor (DO NOT read) Don’t know / No opinion
CQ future #4a If Below Average or Poor: In what way was it [below average or poor]?		X X X X X

CLOSING
Well, _________________(Respondents Name), thank you very much for your patience and cooperation in answering our questions. Have a good evening.

Public reporting burden for this survey is estimated to average 15 minutes per response. Burden means the time, effort and financial resources that you use to generate, maintain, retain, disclose, or provide information to us. You may send comments regarding this form including suggestions for reducing the burden to: Information Collections Management, Federal Emergency Management Agency,

Fema Form 90-149 Page 33 of 33