Document
OMB# 0596-0129
ICR 200903-0596-002 · OMB 0596-0129 · Object 12816401.
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Document Metadata
| File Type | application/msword |
|---|---|
| File Title | OMB# 0596-0129 |
| Author | Mimi |
| Last Modified By | Writer |
| File Modified | 2009-07-28 |
| File Created | 2026-09-13 |
| Conversion State | complete |
Extracted Text
OMB# 0596-0129 Group # Exp. X/XX/20XX Date FORM B Site Location 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) _____________ 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. Concerns about my safety from crime have changed the way I do things at this recreation site in the following ways. (Check all that apply to your safety concerns) ___ I choose to recreate in areas with other people already there. ___ I pay more attention to what is going on around me. ___ I carry a cell phone. ___ I dress conservatively. ___ I chose this site over others because I think it’s safe. ___ I leave my itinerary with friends or family. ___ I am concerned but have not changed the way I do things. ___ I am not concerned about my safety from crime at this site. ___ Other (Please describe) _______________________________________________________________ 6. How concerned are you about each of the following at this recreation site? Please circle the one number that best describes your level of concern. If you are not sure, mark ‘dk’. (Circle one number for each statement) Level of Concern at this Site Concerns not at all concerned slightly concerned somewhat concerned very concerned extremely concerned don’t know a. Gangs are moving into area 1 2 3 4 5 dk b. Drug dealers moving into area 1 2 3 4 5 dk c. Police are around more 1 2 3 4 5 dk d. Traffic, speeding 1 2 3 4 5 dk e. Threats to my health or life by wildfire 1 2 3 4 5 dk f. Vandalism to signs 1 2 3 4 5 dk g. Vandalism to trees 1 2 3 4 5 dk h. Security of my car from break-ins 1 2 3 4 5 dk i. Someone harassing me 1 2 3 4 5 dk j. Carving of names, initials, or messages on trees 1 2 3 4 5 dk k. Discourteous behavior of other people 1 2 3 4 5 dk l. Dogs walked off leash 1 2 3 4 5 dk 7. How concerned are you about each of the following in the neighborhood where you live? Please circle the one number that best describes your level of concern. If you are not sure, mark ‘dk’. (Circle one number for each statement) Level of Concern in Neighborhood Concerns not at all concerned slightly concerned somewhat concerned very concerned extremely concerned don’t know a. Gangs are moving into area 1 2 3 4 5 dk b. Drug dealers moving into area 1 2 3 4 5 dk c. Police are around more 1 2 3 4 5 dk d. Traffic, speeding 1 2 3 4 5 dk e. Threats to my health or life by wildfire 1 2 3 4 5 dk f. Vandalism to signs 1 2 3 4 5 dk g. Vandalism to trees 1 2 3 4 5 dk h. Security of my car from break-ins 1 2 3 4 5 dk i. Someone harassing me 1 2 3 4 5 dk j. Carving of names, initials, or messages on trees 1 2 3 4 5 dk k. Discourteous behavior of other people 1 2 3 4 5 dk l. Dogs walked off leash 1 2 3 4 5 dk 8. Your gender _____ Female _____ Male 9. Your age _____ years 10. 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 11. Are you of Hispanic or Latino origin? ___ Hispanic or Latino ___ Not Hispanic or Latino 12. 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 13. What language do you speak most of the time? ___ English ___ Spanish ___ Other ___________ What language do you read most of the time? ___ English ___ Spanish ___ Other ___________ 14. Place of birth _____ United States _____ Other country __________________________ 15. 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.