Form DHS Form 801 DHS Form 801 Recovery Workshop Satisfaction Survey

D epartment of Homeland Security OMB Control Number: 1601-NEW

Private Sector Office Expiration date: MM/DD/YYYY

RECOVERY WORKSHOP SATISFACTION SURVEY

Privacy Act Notice

The purpose of this survey is to assess the specific needs of the [LOCATION] business community as well as the effectiveness of the initial recovery effort following [EVENT]. Participation in this survey is voluntary. Individual responses will not be revealed to any unauthorized party. 6 U.S.C. §112(f) authorizes the collection of this information. This information will be used towards the purpose of creating and fostering strategic communications with the private sector to enhance the primary mission of the Department to protect the American homeland.

Paperwork Reduction Act

An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1601-NEW and this form will expire on mm/dd/yyyy. The estimated average time to complete this survey is 15 minutes per respondent. If you have comments regarding this survey you can write to:

Gary S. Becker, Department of Homeland Security, Private Sector Office, Washington, DC 20528; [email protected] ; (202) 282-9013

Name: ________________________________________________________________________

Company: _____________________________________________________________________

Address: ______________________________________________________ Zip: ____________

Before the workshop, how beneficial did you expect attending the workshop would be for your business?

Very Little Benefit						Very Beneficial
	1	2		3	4		5

Compared to your expectations, how beneficial was the workshop to your business?

Worse Than Expected						Better Than Expected
	1	2		3	4		5

What was your purpose for attending the workshop? Select all that apply

	Learn about resources for recovering businesses		Offer services and resources
	Obtain information about contracting opportunities		Apply for a loan or grant
	Timetable for utility restoration and other local services	
	________________________________________________________________________
	________________________________________________________________________

Survey continues on reverse side

Which specific recovery issues are currently the most important to your business?

Please list up to three and indicate how well the workshop addressed these issues.

1. ___________________________________________________________________________

Not Adequately Addressed						Addressed Very Well
	1	2		3	4		5

2. ___________________________________________________________________________

Not Adequately Addressed						Addressed Very Well
	1	2		3	4		5

3. ___________________________________________________________________________

Not Adequately Addressed						Addressed Very Well
	1	2		3	4		5

Additional comments or suggestions:

DHS Form 801 (10/07) Page 2 of 2