OMB# 0596-0129 |
Group # |
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Exp. X/XX/20XX |
Date |
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FORM A |
Site Location |
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Welcome to Your National Forest!
To help understand visitor preferences and provide the best services possible at day use sites on the National Forests of Southern California, we are asking if you will take about 8 minutes to fill out this questionnaire. Your participation is voluntary. All responses will be kept anonymous.
1. Have you ever been to this site before? ____ No ____ Yes
If yes, about how many times in the past 12 months? _______times
If yes, about how many years have you been coming here? _______years
2. Do you plan to return to this site again in the next 12 months?
____ No ____ Yes ____ Don’t know
3. Which of the following statements describe why you visit this recreation site? (Check all that apply)
___ |
Being at this site reminds me of my childhood recreation experience. |
___ |
I am comfortable with this site because I have been here before. |
___ |
This site is close to my home. |
___ |
This site is peaceful and quiet. |
___ |
Visiting here is affordable. |
___ |
I meet my friends and/or family here. |
___ |
This is my first visit to this site. |
___ |
I like the activities I can do here. |
___ |
Other (Please describe) _____________ |
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4. Please indicate which of the following activities you participated in while on the visit to this National Forest when our field team contacted you. (Check all that apply)
___ |
Fishing |
___ |
Picnicking/barbeque |
___ |
Swimming/wading |
___ |
Rock climbing |
___ |
Hiking |
___ |
Photography |
___ |
Nature study (for example, bird watching, identifying wildflowers, rock study) |
___ |
Collecting berries, mushrooms, or other |
___ |
Relaxing |
___ |
Other, please specify __________________ |
5. The Forest Service manages public lands, including natural areas that are set aside for various purposes. Please indicate how much you agree or disagree with each of the following statements. If you are not sure, mark ‘dk’. (Circle one number for each statement)
Managing Natural Areas |
||||||
It is important to manage natural areas for: |
strongly disagree |
disagree |
neither |
agree |
strongly agree |
don’t know |
a. Day hiking |
1 |
2 |
3 |
4 |
5 |
dk |
b. Educational purposes |
1 |
2 |
3 |
4 |
5 |
dk |
c. Fishing |
1 |
2 |
3 |
4 |
5 |
dk |
d. Improved air quality |
1 |
2 |
3 |
4 |
5 |
dk |
e. Long-term study of the relationships between weather, fire patterns, plants, animals, and soils. |
1 |
2 |
3 |
4 |
5 |
dk |
f. Mountain bike riding |
1 |
2 |
3 |
4 |
5 |
dk |
g. Picnicking at developed sites (with grills/tables/toilets) |
1 |
2 |
3 |
4 |
5 |
dk |
h. Protection of plants |
1 |
2 |
3 |
4 |
5 |
dk |
i. Protection of water quality |
1 |
2 |
3 |
4 |
5 |
dk |
j. Protection of wildlife |
1 |
2 |
3 |
4 |
5 |
dk |
k. Scenic value |
1 |
2 |
3 |
4 |
5 |
dk |
l. Sightseeing |
1 |
2 |
3 |
4 |
5 |
dk |
m. Stream play |
1 |
2 |
3 |
4 |
5 |
dk |
n. Swimming |
1 |
2 |
3 |
4 |
5 |
dk |
o. Healthful activities |
1 |
2 |
3 |
4 |
5 |
dk |
6. Considering each of the following possibilities for natural areas (including forestlands and parks), please indicate if you think that more areas are needed for this purpose (mark more or a lot more), that there is the right amount (same), or that there are too many areas for the purpose (mark less or a lot less). If you are not sure, mark ‘don’t know’. (Circle one number for each statement)
Natural Area Availability |
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I think that more or fewer natural areas are needed for: |
a lot less |
less |
same |
more |
a lot more |
don’t know |
a. Day hiking |
1 |
2 |
3 |
4 |
5 |
dk |
b. Educational purposes |
1 |
2 |
3 |
4 |
5 |
dk |
c. Fishing |
1 |
2 |
3 |
4 |
5 |
dk |
d. Improved air quality |
1 |
2 |
3 |
4 |
5 |
dk |
e. Long-term study of the relationships between weather, fire patterns, plants, animals, and soils. |
1 |
2 |
3 |
4 |
5 |
dk |
f. Mountain bike riding |
1 |
2 |
3 |
4 |
5 |
dk |
g. Picnicking at developed sites (with grills/tables/toilets) |
1 |
2 |
3 |
4 |
5 |
dk |
h. Protection of plants |
1 |
2 |
3 |
4 |
5 |
dk |
i. Protection of water quality |
1 |
2 |
3 |
4 |
5 |
dk |
j. Protection of wildlife |
1 |
2 |
3 |
4 |
5 |
dk |
k. Scenic value |
1 |
2 |
3 |
4 |
5 |
dk |
l. Sightseeing |
1 |
2 |
3 |
4 |
5 |
dk |
m. Stream play |
1 |
2 |
3 |
4 |
5 |
dk |
n. Swimming |
1 |
2 |
3 |
4 |
5 |
dk |
o. Healthful activities |
1 |
2 |
3 |
4 |
5 |
dk |
7. Your gender _____ Female _____ Male
8. Your age _____ years
9. What was your last year of school completed? (Please circle the number of the last year of school completed)
Elementary School |
Middle School |
High School |
College |
Graduate School |
1 2 3 4 5 |
6 7 8 |
9 10 11 12 |
13 14 15 16 |
17 18 19 20 |
10. Are you of Hispanic or Latino origin? ___ Hispanic or Latino ___ Not Hispanic or Latino
11. What racial category or categories best describes you? (Please select one or more)
___ |
American Indian or Alaska Native |
___ |
Native Hawaiian or Other Pacific Islander |
___ |
Asian |
___ |
White |
___ |
Black or African American |
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12. What language do you speak most of the time?
___ English ___ Spanish ___ Other ___________
What language do you read most of the time?
___ English ___ Spanish ___ Other ___________
13. Place of birth _____ United States _____ Other country __________________________
14. What is your annual household income (before taxes)?
_____ $25,000 or less
_____ $25,001 - $50,000
_____ $50,001 - $75,000
_____ $75,001 - $100,000
_____ $100,001 or more
Thank You So Much!
Enjoy your stay on your National Forest.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0129. The time required to complete this information is estimated at 8 minutes per response, including the time for reviewing instructions, searching data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
The U.S. Department if Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA TARGET Center at 202-720-2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 975-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.
File Type | application/msword |
File Title | OMB# 0596-0129 |
Author | Mimi |
Last Modified By | usda |
File Modified | 2009-07-28 |
File Created | 2009-07-28 |