Form FEMA Form 90-148 FEMA Form 90-148 Helpline Survey

Federal Emergency Management Agency (FEMA) Individual Assistance Customer Satisfaction Surveys

FF90-148 Helpline Survey 20070718

Helpline Survey -- Phone Survey

OMB: 1660-0036

Document [doc]
Download: doc | pdf

HELPLINE SURVEY OMB Control No. 1660-0036

(May 24, 2007)




Hello, I’m calling on from 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 “Unavailable”, add a Comment with a time to call tonight: Thank you for your time and have a nice evening.


If yes: You placed a call to one of our offices _____ days ago inquiring about your application for disaster assistance. Do you remember speaking with _______________(HSR name)?


If no, document the Attempt Field as “Do Not Remember”: Okay, (applicant name), that’s all we needed today. 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. Would you volunteer to take about 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 that your responses 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.












FEMA OVERALL QUALITY


Question

Response Options

All right, (Applicant’s name), we”ll start with a very general question about the service you received from FEMA.


1. Overall, how would you rate the information and support you’ve received from FEMA since the disaster occurred? Would

you say it’s been…

(READ list)


(If “below average” or “poor”, go to Q1a, otherwise skip to Q.1b)


  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion


1a. In what way was the information and support you received (below

average/poor)?


(DO NOT read list)

  • Did not receive enough / any financial assistance

  • Poor Customer Service (Attitude, Respect, Interest, etc.)

  • Process too complicated

  • Information inconsistent or wrong, programs not explained clearly

  • Dissatisfaction with Inspection

  • Took too long to process

  • Difficulty reaching FEMA

  • Insurance related issues (ie: has coverage but no funds from FEMA)

  • Other (Put specific response in comments box)



REASON FOR CALLING HELPLINE


Now I would like you to think about your call to FEMA’s Helpline when you spoke with (HSS Name), the Helpline Representative.

Question

Response Options


1b. What was the specific reason you called FEMA’s helpline?

(DO NOT read list)



  • Status of application

  • Ask a question: fax number, was correspondence received, etc

  • Add to or Correct the information in my file

  • Response to correspondence or phone call from FEMA

  • Request or Appeal for additional funds or due to denial

  • Inspection issues

  • Other (Put specific response in comments box)





HL REPRESENTATIVE QUALITY


Question

Response Options

  1. How would you rate the way the representative you spoke with handled your call? Would you say the (HSS name/the representative was …………………


(READ list)

(If “Below average” or “Poor”, go to Q. 2a, otherwise skip to Q.2b.)


  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion


2a. In what way was your call [below average / poor]?


(DO NOT read list)

  • Didn’t receive enough / any enough assistance

  • Poor attitude

  • Process too complicated

  • Didn’t explain programs clearly or could not answer my questions

  • Didn’t seem interested in helping me

  • Didn’t take time to listen to me

  • Took too long to answer questions or process

  • Rep made errors in my case

  • Didn’t treat me with respect

  • Other (Put specific response in comments box)



HL REPRESENTATIVE – ATTRIBUTE SERIES


You may have already answered some of these questions; but, just to make sure I understand your opinions, I am going to ask you some specific questions about the representative you spoke with

Question

Response Options

2b. How would you rate the (HSS name/ representative on) showing a
genuine interest in your situation?

(Read list AS NEEDED)

  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion

2c. on taking the time to listen to the details of your situation?

(Read list AS NEEDED)

  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion

2e. on treating you with respect?

(Read list AS NEEDED)



  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion

2f. How would you rate {HSS name / the Helpline Representative} overall

attitude during the call? Would you say it was……………

(Read list AS NEEDED)

(If “Below average” / “Poor” go to Q.2g., otherwise skip to Q.2h.)

  • Excellent

  • Good

  • Satisfactory

  • Below Average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion

2g. How was {HSS name / the Helpline representative’s attitude {below

average / poor}?


(DO NOT read list)

  • Condescending, Disrespectful

  • Impatient; Did not Listen

  • Rude / Discourteous

  • Not interested, No compassion nor empathy

Other (Put specific response in comments box)



HL REPRESENTATIVE – ANSWERING QUESTIONS


Question

Response Options

2h. How would you rate (HSS Name/ Helpline representative on answering any questions you may have called about? Would you say it was

(Read list)

(If “Below average” / “Poor”, go to Q.2i, otherwise skip to Q.3.)

  • Excellent

  • Good

  • Satisfactory

  • Below Average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion

2i. What questions was (HSS Name / Helpline representative) unable to answer?


(DO NOT read list)

  • ONA amount, status, program

  • Appeal process for more funds or explanation of denial

  • Chainsaw, generators, wet/dry vacs, etc.

  • Rental, Hotel/Motel (Lodging reimbursement)

  • Conflicting or unclear answers

  • Faxes, Correspondence, Funds (Timeframe explanation)

  • Other (Put specific response in comments box)



POST-DISASTER COMMUNICATION


Now, I’d like to ask you some general questions about FEMA.

Question

Response Options

3. After the disaster, how did you hear about FEMA?

(DO NOT read list)

(If only Friends/Relatives is checked skip to Q4)

Probe once: How else did you hear about FEMA or find out how you could apply for disaster assistance? (Accept multiple responses)

  • Newspaper

  • Friends / Relatives

  • Radio

  • FEMA Employees

  • Community Groups


  • Television

  • Flyers

  • Church

  • Other (Put specific response in comments box)

3a. How would you rate the effectiveness of the communications in helping you get the information you need? Would you say it was…

( (READ list)


(If “Below average” / “Poor”, go to 3b, otherwise skip to Q.4. If “Don’t know” / “No opinion”, skip to Q.4.

  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion

3b. What made the communication ineffective?




(Do not read list. Mark all that apply.)

  • The information did not accurately represent the services provided by FEMA

  • The information was confusing

  • Information was Insufficient or too late

  • Did not receive enough / any financial assistance

  • Had to seek out information on my own

  • Other (Put specific response in comments box)





CALL CENTER ACCESS


Question

Response Options

  1. When you called FEMA’s Helpline {this time}, did you have any difficulty reaching a FEMA representative?

(DO NOT read list.) (If “YES” go to Q.4a., otherwise, skip to Q.5.”)



  • Yes

  • No

  • Don’t remember / No opinion

4a. What difficulty did you have?


(DO NOT read list)

  • Busy, recording to Call Back

  • Took to long to answer or on Hold too long

  • Transferred too many times
  • Phone Line/Computer System Problems

  • Other (Put specific information in comments box)

INFORMATION PACKET


Question

Response Options

Now I’d like to ask you about the information packet FEMA mailed to you .

  1. Have you received it?

(DO NOT read list)


(If “yes”, go to Q.5a, otherwise skip to Q.7.)

  • Yes

  • No

  • Don’t know / Can’t remember



5a. How would you rate the information in this packet? Would you say it

was…

(READ list)

(If “Below average” / “Poor”, go to Q.5b, otherwise skip to Q.6.)

.


  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor


5b. Why is that?

(DO NOT read list)

  • Confusing, too Complex, Hard to Understand, Not Clear, Bureaucratic

  • Not Accurate, misleading of not benefit

  • Insufficient detail/information

  • Language Issues

  • Other (Put specific response in comments box)




APPLICANT’S GUIDE


Question

Response Options

As part of the information packet, you may have received a booklet called “Help After a Disaster: Applicant’s Guide to the Individual and Households Program.”

6. Have you had a chance to read the guide?

(DO NOT read list)


(If “yes”, go to Q.6a, otherwise skip to Q.7.)

  • Yes

  • No .

  • Don’t know / Can’t remember



6a. How would you rate the Applicant’s Guide on helping you

understand the disaster assistance programs available to you?

Would you say it was………..

(READ list)

(If “Below Average” / “Poor”, go to Q.6b, otherwise skip to Q.7)

  • Excellent

  • Very good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read)Don’t know / No opinion


6b. How was it (Below Average/Poor)?

(DO NOT read list)

  • Confusing, too complex, hard to understand, not clear, bureaucratic

  • Not accurate, misleading or of no benefit

  • Insufficient detail/information

  • Too much information

  • Other (Put specific response in comments box)











FEMA CORRESPONDENCE


Question

Response Options


7. How would you rate FEMA’s letters on being easy to understand?

(READ list)




(If “Below average” / “Poor”, go to 7a, otherwise skip to Q.8.)



  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion

  • (DO NOT read) No letters received yet


7a. In what way were FEMA’s letters (below average / poor)?

(DO NOT read list. Mark all that apply.)





  • Seemed too complicated / confusing

  • Had to call Helpline for explanation

  • Insufficient information / details

  • Language Issues

  • Information not received in a timely manner

  • Too much information

  • Uncertain what to do next

  • Other (Put specific response in comments box)
















INSPECTION SERIES


Question

Response Options

Now, I’d like you to think about the inspection FEMA conducted to assess your damages.

I see you had multiple inspections. Which one would you like to be surveyed about?

8a. How many days after your call did FEMA conduct the

inspection?

(If needed, probe once with “What is your closest estimate?”)

(ENTER EXACT NUMBER OF DAYS (0 is ok). DO NOT ACCEPT A RANGE)

  • [______]Initial inspection

  • [______]Second inspection



  • [______] [____]


8b. How would you rate the amount of time between your call and the inspection? Would you say it was……….

(READ list)


  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion


8c. Overall, how satisfied are you with the inspection FEMA conducted?

Would you say you are…..

(READ list)

(If “Less than satisfied” / “Not at all satisfied”, go to 8d, otherwise, skip to Q.9.)

  • Extremely satisfied

  • Very satisfied

  • Satisfied

  • Less than satisfied

  • Not at all satisfied

  • (DO NOT read) Don’t know / No opinion


8d. Why were you dissatisfied with the inspection?




(DO NOT read list. Mark all that apply)

  • Not qualified, No financial assistance or not enough

  • Poor customer service

  • Did not look at all my damages

  • Did not listen to me

  • Did not explain anything to me

  • Did not answer my questions

  • Did not come at scheduled time

  • Did not take enough time

  • Other (Put specific response in comments box)





REPUTATION IN COMMUNITY


Next, I’d like you to think about the image FEMA has in your community.

Question

Response Options


  1. Based on what you have 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” / “poor”, go to Q8a, otherwise skip to Q9.)


  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion


9a. What do you think the reason would be?






(DO NOT read list. Mark all that apply.)


  • Poor Customer Service

  • Process too complicated

  • No consistency in amount awarded

  • FEMA didn’t seem interested in helping me

  • Took too long to get assistance

  • Disaster assistance information mis-communicated

  • Not enough money awarded

  • Was told I did not qualify for assistance

  • Too much red tape to get assistance

  • Dissatisfaction with Inspection

  • Other (Put specific response in comments box)












AGENCY REFERRALS


Don’t Read: Referrals will auto-populate by “highlighting only those agencies to which the applicant was referred at the time of application. If no referrals, program will go to Q.10.

Question

Response Options

When you initially registered for disaster assistance, did we refer you to other agencies that may also be able to provide you with assistance? (DO NOT read list)

  • Yes (GO TO 9a)

  • No (Skip to 9b)

  • Don’t remember (Skip to 9b)

10a. Which Agencies were you referred to?







(Check highlighted agencies respondent recalls, and go to 10b)

REFERRED AGENCIES


(HIGHLIGHTED AGENCIES WERE REFERRED)



RECALLS

REFERRAL

SMALL BUSINESS ADMINISTRATION

AMERICAN RED CROSS

FARM SERVICES AGENCY

DISASTER UNEMPLOYMENT ASSISTANCE

INTERNAL REVENUE SERVICE

INSURANCE COMPANY

OTHER

10b. Based on your application, you may have been referred to (read highlighted referrals that applicant did not identify in 9a). Would you like me to give you the contact information so you can contact them when you have an opportunity?

  • Yes (give Contact Information from NEIMIS)


  • No (Go to Q.10)


Note: If respondent has not contacted insurance company, explain importance of filing claim and supplying FEMA with a letter of denial or settlement.


SUGGESTIONS TO IMPROVE


Question

Response Options

For this next question, FEMA is interested in getting your opinion on what we could do to improve our service.

11. What suggestions would you like to pass on to FEMA?

(Probe once with “WHAT OTHERS”)


Open-ended Question

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 available at 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 personally, attempt to do your Registration over the Internet?

If no go to Question CQ IAC-Reg#1a.

If yes go to Question CQ IAC-Reg#1b.

If Don’t remember, go to Next Question


  • Yes

  • No

  • (DO NOT read) Don’t remember

CQ IAC-Reg#1a. What were your reasons for not using the internet?



(DO NOT Read List, listen and mark all that apply)

  • Don’t have a COMPUTER

  • Don’t have Internet ACCESS

  • Computer DAMAGED

  • Limited computer SKILLS

  • SECURITY Concerns

  • WEBSITE was not accessible

  • Wanted to TALK to FEMA

  • DIDN’T KNOW I could register on-line

  • UTILITIES were out could not use computer

  • Other (Specify)

CQ IAC-Reg#1b. 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 NAVIGATE FEMA.gov

  • GENERAL instructions not clear

  • SPECIFIC instructions for entering data not clear

  • Too COMPLICATED / difficult to use

  • Not confident so ALSO registered over the phone

  • Unable to ACCESS the site of page

  • Difficulty with characters on SECURITY SCREEN

  • Response time too slow

  • Could not complete due to TECHNICAL problems

  • HELP DESK could not answer to technical questions

  • 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 on the FEMA.gov website where you may view your account 24 hours a day 7 days a week. This includes checking your eligibility and inspection status, correspondence or making minor changes to insurance or contact information.


CQ IAC-Inq # 1. Did you try to use the FEMA.gov website to check on your application?

If no, go to CQ IAC-Inq#1a

If yes go to Question CQ IAC-Inq #1b

If don’t remember, Go to Next Question


  • Yes

  • No

  • (DO NOT read) Don’t remember

CQ IAC-Inq#1a What were your reasons for not using the internet?

  • Don’t have a computer

  • Don’t have internet access

  • Computer damaged

  • Limited computer skills

  • Security concerns

  • Website was not accessible

  • Wanted to talk to FEMA

  • Didn’t know about the on-line service

  • Utilities were out; could not use computer

CQ IAC-Inq #1b. Why were you unable to use the Individual Assistance Center Website to inquire into your case?

  • Did not have compatible browser

  • Unable to navigate FEMA.gov

  • Instructions were not clear

  • Could not complete due to technical problems

  • Helpdesk could not answer technical questions

  • Not confident changes were made / called Helpline to verify

  • Unable to access the site or page

  • Difficulty with logon, pin, password

  • Response time too slow

  • Too complicated / difficult to use

  • Information I wanted was not available

  • Took too long to view / edit my information

  • Other (Specify)



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 mail was returned. (It may 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 recorded message from FEMA stating your correspondence or fax was received or mail was returned? (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;

Otherwise, continue to CQAD#1c:


  • 1) Fax or Correspondence received at FEMA

  • 2) App’s Mail Returned to FEMA

  • 3) FEMA Letter to App - X

  • 4) FEMA Letter to App - Y

  • 5) FEMA Letter to App – Z

  • 6) EFT

  • 7) Registration received

  • 8) Inspection Scheduled

  • 6) Do not Remember

  • 7) Other (specify)

If 3) or 4) or 5) 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?

  • 0 number of times

  • 1

  • 2

  • 3

  • 4

  • 5

  • More than 5

CQAD#1ca. Was that ____ (number) just right, okay or too many?

  • Just right

  • Okay

  • Too many


CUSTOM QUESTIONS – Auto Dialer Feature

continued

CQAD#1d How did you feel about the time of day you received the recording. Was it convenient for you?

If no, go to CQAD #1da , if Yes or Don’t Know, go to CQAD#1

  • Yes

  • No

  • Don’t know/No opinion

CQAD#1da What time of day did you receive the recording?

  • _______ cst

  • on a ____day

CQAD#1e. How helpful was that recording?

(Read list.)


(If Somewhat helpful, Not very helpful or Not at all helpful, go to CQAD#1ea)

  • Extremely helpful

  • Very helpful

  • Somewhat helpful

  • Not very helpful

  • Not at all helpful

  • (do not read) Don’t know/No opinion

CQAD#1ea. 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

  • 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. Did you need to call the FEMA Helpline after you heard the recording?

If yes, go to CQAD#1fa

  • Yes

  • No

  • Do not Remember

CQAD#1fa. What help did you need?


(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#1g. Was the HL representative knowledgeable about the recorded message you received?

  • Yes

  • No

  • Do not Remember

CQAD#1h. What suggestions do you have to improve this recorded message feature? [If any, enter the suggestion]






CUSTOM QUESTIONS – Automated Information System (IVR)

5-24-07


Question

Response Options

Another service FEMA has is an automated information system to let applicants check the status of their application over their phone.

(Ask CQIVR#1 only if the information is not available electronically).

CQIVR#1. Have you used this automated method to check the status of your case?

(Do not READ list)

If No or Do not Remember, go to Next Question.

If yes to CQIVR#2


  • Yes

  • No

  • Do not Remember


CQIVR#2. Were the instructions on the automated system easy to understand?

(Do not READ list)

If No, go to CQIVR#2a. If Yes or Do not Remember, go to CQIVR#3.

  • Yes

  • No

  • Do not Remember

CQIVR#2a. What made it difficult?


(Do not READ list. Check all that apply)


  • Terminology was confusing

  • Did not know what it meant

  • Did not know what to do next

  • Could not hear due to hearing issues

  • Could not hear due to phone issues

  • Could not hear due to recording not clear

  • Language or dialect issues

  • Other

CQIVR#3. 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#3a. Otherwise, go to CQIVR#5.

  • Extremely Helpful

  • Very Helpful

  • Somewhat Helpful

  • Not very Helpful

  • Not at all Helpful

  • (DO NOT read) Don’t know / No opinion


CUSTOM QUESTIONS – Automated Information System (IVR)

continued

Question

Response Options

CQIVR #3a. Tell me a little about that experience.


(Do not Read the list. Check all that apply.)


  • Confusing terminology

  • Could not navigate

  • Could not skip through

  • Did not understand the status

  • Instructions not clear

  • Instructions too long

  • Had to contact Helpline (record Yes in CQIVR#4)

  • Had to punch too many numbers

  • Had to start over

  • Needed additional information

  • No way to repeat the needed instruction

  • No way to go back to the beginning

  • Not confident the status was accurate

  • Poor sound quality

Other (record specific reason)

For all responses:

CQIVR#4. After you used the automated system, did you need to speak to a FEMA Helpline Representative for additional information or clarification?

If yes, go to CQIVR#4a If No or Do not Remember, go to CQIVR#5.

  • Yes

  • No

  • Tried but was not able to Reach the HL

  • Do not Remember

CQIVR#4a: At the beginning of the automated message, you were prompted to select specific numbers. After you made your menu selections, was your call transferred correctly and were you able to speak to a Helpline agent?

If No, go to CQIVR#4b

If Yes, go to CQIVR#4c

  • Yes

  • No

  • Do not Remember


CQIVR#4b: What happened to your call?

  • Got the wrong selection

  • Had to start over

  • Could not skip through the prompts

  • Had to wait for the Spanish script to end

  • Spoke too fast

  • Other


CUSTOM QUESTIONS – Automated Information System (IVR)

continued

Question

Response Options

CQIVR#4c. What additional information did you need?


(Do not Read the list. Check all that apply.)

  • To be sure the automated message was correct

  • To understand the status

  • To ask how to appeal

  • To ask what to do next

  • 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

  • To ask which of my documents had been received

  • To ask if my documents had been received

  • Other (specify)

CQIVR#4d. Was the HL representative knowledgeable about the message you heard on the automated information system?

  • Yes

  • No

  • Do not Remember

CQIVR#5: If you needed to, would you use the automated system again?

  • Yes

  • No

CQIVR#6. What suggestions do you have to improve the automated system? [If any, enter the suggestion]



SPECIAL NEEDS CUSTOM QUESTION – Through “yes” response to NEMIS RI question about Support Loss for Special Needs: "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?” A “yes” response indicates the applicant had help or support and have lost that help or support because of the disaster including the following: Mobility, Hearing/Speech, Cognitive/Mental Health, Vision an Other. OR Data provided by Special Needs Coordinator when disaster specific needs are identified; such as, over age 60 or Community Relations, DRC, ISC, EOC or another Agency identifies a need, or the Long Term Recovery Committee has exhausted all resources.

Rev 5-24-07

We are calling Applicants who indicated they have additional needs and who have been contacted by a FEMA Special Needs Caseworker (from the JFO) to see if assistance is available:

QUESTION

RESPONSE

CQSN#1

Has a FEMA Special Needs Caseworker given you a courtesy call about your needs for support after the disaster?


If Yes: What was the name of the FEMA person who contacted you?______ (If not do remember, leave blank and skip CQSN#2)


If Do Not Remember: Skip to the next Custom Question

Yes

No

Do not Remember



(Use of JFO database will provide this answer. Skip to CQSN#1a)



CQSN#2

Overall, how would you rate the way the Special Needs Caseworker handled that call? Would you say ____/the disaster worker was…

Excellent

Good

Satisfactory

Below Average

Poor

Do not know/no opinion

CQSN#2a

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:


SPECIAL NEEDS CUSTOM QUESTION

Page 2

QUESTION

RESPONSE

CQSN#3

How would you rate _____/ (the Special Needs Caseworker) 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#3a

If Below Average or Poor: What programs and services were ___/ (the Special Needs Caseworker) 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#4

During this contact, were you referred to another agency (or agencies) for assistance?


If no (This concludes the SN questions, go to next Custom Question)


If yes, go to CQSN#5

Yes

Which one(s)? ______, _______, _______

(Use of JFO database will provide this answer. Skip to CQSN#5)


No

CQSN#5

Did you contact that agency (those agencies)?


If yes, go to CQSN#6

If any other response, go to next Custom Question

Yes

No

Tried but was not able

Decided not to

Do not Remember


SPECIAL NEEDS CUSTOM QUESTION

Page 3

QUESTION

RESPONSE

CQSN#6

For the 1st Agency: How would you rate the overall assistance provided by ________ (agency)?

Excellent

Good

Satisfactory

Below Average

Poor

Do not know/no opinion

CQSN#6a

If Below Average or Poor: In what way was the assistance [below average or poor]?

Didn’t receive any assistance

Didn’t receive enough assistance

Process was too complicated

Took too long to receive assistance

Rep was not knowledgeable

Rep had poor customer service

Other:

CQSN#7

For the 2nd Agency you were referred to: 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#7a

If Below Average or Poor: In what way was the assistance [below average or poor]?

Didn’t receive any assistance

Didn’t receive enough assistance

Process was too complicated

Took too long to receive assistance

Rep was not knowledgeable

Rep had poor customer service

Other:


SPECIAL NEEDS CUSTOM QUESTION

Page 4

QUESTION

RESPONSE

CQSN#8

For the 3rd Agency: How would you rate the overall assistance provided by ________ (agency)?



Excellent

Good

Satisfactory

Below Average

Poor

Do not know/no opinion

CQSN#8a

If Below Average or Poor: In what way was the assistance [below average or poor]?

Didn’t receive any assistance

Didn’t receive enough assistance

Process was too complicated

Took too long to receive assistance

Rep was not knowledgeable

Rep had poor customer service

Other:



CUSTOM QUESTIONS- CENTRALIZED LOCATION


Question

Response Options

CQCL-1 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


CQCL-2. 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

CQCLa.

CQCLb.

CQCLc.

CQCLd.

CQCLe.

CQCLf.

CQCLg

CQCLh

CGCLi

CQCLj.

CQCLk

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 – Disaster Recovery Center 5-24-07 modification

Question

Response Options

CQDRC#1 (was CQ#3). Following the disaster, did you have an opportunity to visit FEMA’s Disaster Recovery Center?

(If “YES”, go to CQDRC#2, otherwise skip to the next Custom Question.)

  • Yes

  • No

  • Would have gone but there were none located in my area

  • (DO NOT read) Do Not Remember

CQDRC#2 What was the reason you visited the Recovery Center?


(Do not read list, check all that apply)

  • To Register

  • To get general information

  • Check on my FEMA Case

  • Check on my ONA Case

  • Deliver Paperwork for FEMA/ONA

  • Fix the Problems on my Case

  • Visit SBA

  • Get Hazard Mitigation Information

  • Visit other Agencies. Which ones?___ (ARC, Unemployment, etc)

  • Other

CQDRC#3 Were your needs met during that visit?


(If no or not completely, go to CQDRC#4)

  • Yes

  • No

  • Not Completely

CQDRC#4 Why not?

  • No phones to register

  • No internet to register

  • Computers were not set up

  • Needed to furnish additional information

    • Proof of Ownership

    • Proof of Identity

    • Receipts or Estimates

  • Agency I needed was not available that day: Which agency? ____ (ARC, Unemployment, Mitigation, etc.)

  • Center was too busy

  • Center was too noisy

  • No privacy

  • FEMA Rep could not answer my questions

  • SBA Rep could not answer my questions

  • Other


CUSTOM QUESTIONS – Disaster Recovery Center, continued 5-24-07 modification

CQDRC #5 (was #3a). Overall, how would you rate the quality of service you received at that Center? Would you say it was…

(READ list)


(If Excellent, Good or Satisfactory, go to CQDRC#6)

(If “Below average” / “Poor”, go to CQ#7)

  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion

CQDRC#6 If Excellent, Good, Satisfactory: Could you tell me a little about that experience? (If any remarks, enter text)


CQDRC #7. Why do you feel that way?




(DO NOT read list, Mark all that Apply)


  • Difficulty finding DRC

  • Hours of Operation were not convenient

  • Computer System was down

  • Staff had poor attitude

  • Staff didn’t treat me with respect

  • Staff gave no explanation of programs

    • Probe for clarity and

    • Which Programs ? _____

  • Staff tried but could not explain the programs

    • Probe for clarity and

    • Which Programs? ____

  • Staff didn’t take time to listen to me

  • Staff didn’t seem interested in helping me

  • Took too long to get assistance at the DRC

  • Had to return numerous times to provide documentation

  • My documents were lost by the DRC

  • Other (Specify)

CQDRC #8 What was the location of the Center?


  • _______ (specify)

CQDRC #9 What suggestions do you have to improve the service at the Recovery Center? If any, enter the text



CUSTOM QUESTIONS – FUTURE USE


Question

Response Options

CQ1.

(DO NOT read list)

  • Yes

  • No

  • Don’t know / No opinion



CUSTOM QUESTIONS – FUTURE USE


Question

Response Options

CQ2.

(DO NOT read list)

.

  • True

  • False

  • Don’t know / No opinion


CUSTOM QUESTIONS – FUTURE USE


Question

Response Options

CQ3.

(READ list)

  • Extremely likely

  • Very likely

  • Somewhat likely

  • Not very likely, or

  • Not at all likely

  • (DO NOT read) Don’t know / No opinion


CUSTOM QUESTIONS – FUTURE USE


Question

Response Options

CQ4.

(READ list)



  • Excellent

  • Good

  • Satisfactory

  • Below average, or

  • Poor

  • (DO NOT read) Don’t know / No opinion






PERMISSION QUESTION


Question

Response Options

All right, (Applicant’s Name), I have only one more question for you.

12. FEMA is very interested in the quality of service we provide you. May we call you at a later date to ask you some additional questions?

  • Yes

  • No



CLOSING


If “yes,” Great! Thank you very much for your patience and cooperation in answering our questions. Have a good evening.


If “No,” I understand. Thank you very much for taking the time to talk to me. Have a good evening.


Paperwork Reduction Act Notice: Public reporting burden for this survey is estimated to be an average of 15 minutes per response. The burden includes the total time for answering the questionnaire. Although voluntary, you are not required to respond to this collection of information unless a valid OMB control number is presented to you during the interview. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Paperwork Reduction Act Project (1660-0036), Information Collections Management, Federal Emergency Management Agency, Department of Homeland Security, 500 C St. SW, Washington, DC 20472.


FEMA Form 90-148 Page 37 of 37

File Typeapplication/msword
File TitleREGISTRATION INTAKE
Authortxnpsc
Last Modified Byclim
File Modified2007-07-18
File Created2007-07-18

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