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. |
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FEMA OVERALL QUALITY |
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Question |
Response Options |
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All right, (Applicant’s name), we”ll start with a very general question about the service you received from FEMA. |
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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) |
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1a. In what way was the information and support you received (below average/poor)?
(DO NOT read list) |
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REASON FOR CALLING HELPLINE |
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Now I would like you to think about your call to FEMA’s Helpline when you spoke with (HSS Name), the Helpline Representative. |
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Response Options |
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1b. What was the specific reason you called FEMA’s helpline?
(DO NOT read list)
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HL REPRESENTATIVE QUALITY |
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Question |
Response Options |
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(READ list) (If “Below average” or “Poor”, go to Q. 2a, otherwise skip to Q.2b.) |
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2a. In what way was your call [below average / poor]?
(DO NOT read list) |
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HL REPRESENTATIVE – ATTRIBUTE SERIES |
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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 |
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Question |
Response Options |
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2b. How would you rate the (HSS name/ representative on) showing agenuine interest in your situation?(Read list AS NEEDED) |
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2c. on taking the time to listen to the details of your situation? (Read list AS NEEDED) |
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2e. on treating you with respect? (Read list AS NEEDED)
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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.) |
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2g. How was {HSS name / the Helpline representative’s attitude {below average / poor}?
(DO NOT read list) |
Other (Put specific response in comments box) |
HL REPRESENTATIVE – ANSWERING QUESTIONS |
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Question |
Response Options |
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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.) |
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2i. What questions was (HSS Name / Helpline representative) unable to answer?
(DO NOT read list) |
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POST-DISASTER COMMUNICATION |
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Now, I’d like to ask you some general questions about FEMA. |
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Question |
Response Options |
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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) |
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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. |
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3b. What made the communication ineffective?
(Do not read list. Mark all that apply.) |
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CALL CENTER ACCESS |
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Question |
Response Options |
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(DO NOT read list.) (If “YES” go to Q.4a., otherwise, skip to Q.5.”)
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4a. What difficulty did you have?
(DO NOT read list) |
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INFORMATION PACKET |
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Response Options |
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Now I’d like to ask you about the information packet FEMA mailed to you . |
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(DO NOT read list)
(If “yes”, go to Q.5a, otherwise skip to Q.7.) |
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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.) . |
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5b. Why is that? (DO NOT read list) |
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APPLICANT’S GUIDE |
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Question |
Response Options |
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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.” |
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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.) |
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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) |
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6b. How was it (Below Average/Poor)? (DO NOT read list) |
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FEMA CORRESPONDENCE |
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Question |
Response Options |
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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.)
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7a. In what way were FEMA’s letters (below average / poor)? (DO NOT read list. Mark all that apply.)
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INSPECTION SERIES |
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Question |
Response Options |
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Now, I’d like you to think about the inspection FEMA conducted to assess your damages. |
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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) |
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8b. How would you rate the amount of time between your call and the inspection? Would you say it was………. (READ list)
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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.) |
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8d. Why were you dissatisfied with the inspection?
(DO NOT read list. Mark all that apply) |
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REPUTATION IN COMMUNITY |
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Next, I’d like you to think about the image FEMA has in your community. |
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Question |
Response Options |
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(READ list)
(If “below average” / “poor”, go to Q8a, otherwise skip to Q9.) |
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9a. What do you think the reason would be?
(DO NOT read list. Mark all that apply.) |
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AGENCY REFERRALS |
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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. |
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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) |
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10a. Which Agencies were you referred to?
(Check highlighted agencies respondent recalls, and go to 10b)
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REFERRED AGENCIES
(HIGHLIGHTED AGENCIES WERE REFERRED)
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RECALLS REFERRAL |
SMALL BUSINESS ADMINISTRATION |
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AMERICAN RED CROSS |
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FARM SERVICES AGENCY |
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DISASTER UNEMPLOYMENT ASSISTANCE |
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INTERNAL REVENUE SERVICE |
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INSURANCE COMPANY |
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OTHER |
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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? |
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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 |
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Response Options |
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For this next question, FEMA is interested in getting your opinion on what we could do to improve our service. |
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11. What suggestions would you like to pass on to FEMA? (Probe once with “WHAT OTHERS”)
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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 |
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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. |
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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 |
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CQ IAC-Reg#1a. What were your reasons for not using the internet?
(DO NOT Read List, listen and mark all that apply) |
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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.) |
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CUSTOM QUESTIONS – Registration Intake Phone Survey or Helpline Phone Survey Re: Internet Inquiry or Update |
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Question |
Response Options |
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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. |
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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 |
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CQ IAC-Inq#1a What were your reasons for not using the internet? |
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CQ IAC-Inq #1b. Why were you unable to use the Individual Assistance Center Website to inquire into your case? |
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CUSTOM QUESTIONS – Auto Dialer Feature |
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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.) |
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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 |
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(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:
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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? |
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CQAD#1c. How many times did you receive the same message? |
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CQAD#1ca. Was that ____ (number) just right, okay or too many? |
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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 |
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CQAD#1da What time of day did you receive the recording? |
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CQAD#1e. How helpful was that recording? (Read list.)
(If Somewhat helpful, Not very helpful or Not at all helpful, go to CQAD#1ea) |
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CQAD#1ea. In what way?
(DO NOT read list. Mark all that apply.) |
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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 |
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CQAD#1fa. What help did you need?
(DO NOT read list. Mark all that apply.) |
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CUSTOM QUESTIONS – Auto Dialer Feature |
continued |
If CQAD#1f is Yes: CQAD#1g. Was the HL representative knowledgeable about the recorded message you received? |
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CQAD#1h. What suggestions do you have to improve this recorded message feature? [If any, enter the suggestion] |
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CUSTOM QUESTIONS – Automated Information System (IVR) 5-24-07 |
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Question |
Response Options |
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Another service FEMA has is an automated information system to let applicants check the status of their application over their phone. |
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(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 |
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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. |
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CQIVR#2a. What made it difficult?
(Do not READ list. Check all that apply)
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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. |
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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.)
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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. |
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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 |
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CQIVR#4b: What happened to your call? |
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CUSTOM QUESTIONS – Automated Information System (IVR) |
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Response Options |
CQIVR#4c. What additional information did you need?
(Do not Read the list. Check all that apply.) |
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CQIVR#4d. Was the HL representative knowledgeable about the message you heard on the automated information system? |
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CQIVR#5: If you needed to, would you use the automated system again? |
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CQIVR#6. What suggestions do you have to improve the automated system? [If any, enter the suggestion] |
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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 |
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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: |
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QUESTION |
RESPONSE |
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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)
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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 |
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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 |
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QUESTION |
RESPONSE |
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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 |
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QUESTION |
RESPONSE |
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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 |
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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: |
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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 |
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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 |
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QUESTION |
RESPONSE |
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CQSN#8 |
For the 3rd Agency: How would you rate the overall assistance provided by ________ (agency)?
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Excellent Good Satisfactory Below Average Poor Do not know/no opinion |
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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 |
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Question |
Response Options |
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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)
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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) |
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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? |
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CUSTOM QUESTIONS – Disaster Recovery Center 5-24-07 modification |
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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.) |
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CQDRC#2 What was the reason you visited the Recovery Center?
(Do not read list, check all that apply) |
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CQDRC#3 Were your needs met during that visit?
(If no or not completely, go to CQDRC#4) |
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CQDRC#4 Why not? |
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CUSTOM QUESTIONS – Disaster Recovery Center, continued 5-24-07 modification |
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CQDRC
#5 (was #3a). Overall, how would you rate the quality of service (READ list)
(If Excellent, Good or Satisfactory, go to CQDRC#6) (If “Below average” / “Poor”, go to CQ#7) |
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CQDRC#6 If Excellent, Good, Satisfactory: Could you tell me a little about that experience? (If any remarks, enter text)
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CQDRC #7. Why do you feel that way?
(DO NOT read list, Mark all that Apply)
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CQDRC #8 What was the location of the Center?
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CQDRC #9 What suggestions do you have to improve the service at the Recovery Center? If any, enter the text |
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CUSTOM QUESTIONS – FUTURE USE |
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Question |
Response Options |
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CQ1. (DO NOT read list)
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CUSTOM QUESTIONS – FUTURE USE |
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Question |
Response Options |
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CQ2. (DO NOT read list) . |
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CUSTOM QUESTIONS – FUTURE USE |
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Question |
Response Options |
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CQ3. (READ list) |
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CUSTOM QUESTIONS – FUTURE USE |
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Question |
Response Options |
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CQ4. (READ list)
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PERMISSION QUESTION |
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Question |
Response Options |
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All right, (Applicant’s Name), I have only one more question for you. |
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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? |
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CLOSING |
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If “yes,” Great! Thank you very much for your patience and cooperation in answering our questions. Have a good evening.
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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
File Type | application/msword |
File Title | REGISTRATION INTAKE |
Author | txnpsc |
Last Modified By | clim |
File Modified | 2007-07-18 |
File Created | 2007-07-18 |