Corps of Engineers Civil Works Questionnaires Generic Clearance

CUSTOMER FEEDBACK FORM

(Personal Interview)

OMB 0710-0001

Expires: 30 September 2012

The public report burden this information collection is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this data collection, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, and the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503, Attn.: Desk Officer for U.S. Army Corps of Engineers. Respondents should be aware that notwithstanding any other provision of law, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Please DO NOT RETURN your completed form to either of these offices.

Customer Feedback Form

The ________ District is committed to improving our services to you and would like to know how well we’re doing. Please rate your Level of Satisfaction with our performance over the past year, or more recently, in delivering a primary product or service. You may choose to leave an answer blank if the question or choice of response doesn’t seem relevant. Your response is voluntary and not required. Your straightforward answers will help us to improve our service to you. For assistance, please contact ______________________. Thank you for your time and comments.

Date ____________________

Primary Product or Service (please enter a checkmark in the most appropriate space below)

___ Navigation (river transportation)

___ Flood Damage Reduction

___ Ecosystem Restoration ___ Real Estate

___ Infrastructure Rehabilitation (water and sewer systems) ___ Regulatory (permits)

___ Recreation (camping, boating, and other activities) ___ Streambank Protection

___ Emergency Management (emergency response) ___ Other

___ Technical Assistance (program or project advice)

If other, please specify _____________________________________________

Current Phase of Project (please enter a checkmark in the most appropriate space below)

___ Reconnaissance/Feasibility (project study)

___ Pre-Construction Engineering and Design (project design)

___ Construction

___ Operations and Maintenance

___ Facility User/Visitor at Site

___ Other

If other, please specify _____________________________________________

The ________ District: Satisfaction Scale

(Check one box for each response. N/A means not applicable.)

Very Dissatisfied

Dissatisfied

Undecided

Satisfied

Very Satisfied

Not Applicable

1 2 3 4 5 N/A

1. S eeks your requirements, priorities, and expectations,

and incorporates them into products/services provided

2. M anages your projects/programs effectively

3. T reats you as an important member of the team

4. S olicits, listens to, and resolves your concerns

5. P rovides timely products/services

6. D elivers products/services at the quality level you need

7. D elivers products/services at a reasonable cost

8. Is responsive to your needs

9. K eeps you informed

10. A nswers your questions

Your Overall Level of Satisfaction

Very Dissatisfied

Dissatisfied

Undecided

Satisfied

Very Satisfied

Not Applicable

1 2 3 4 5 N/A

• C ourtesy of our employees

• K nowledge and reliability of our employees

• P oints of contact well-defined

• Clarity of forms, publications, process descriptions,

advice, and correspondence

What is the likelihood that you would choose the Corps of Engineers for Future Products and Services?

Very Dissatisfied

Dissatisfied

Undecided

Satisfied

Very Satisfied

Not Applicable

1 2 3 4 5 N/A

What are your expectations of us (in prioritized order)?

1. ______________________________________________________________________________________________________________________________________________________________

2. ______________________________________________________________________________________________________________________________________________________________

3. ______________________________________________________________________________________________________________________________________________________________

Comments/Suggestions: ________________________________________________________________________________________________________________________________________________

While the following information is not required, specifying the project would be helpful.

• Corps Project/Program Name _________________________________________

• Your organization name _________________________________________

Thank you for your feedback.

Please return this form to: U.S. Army Engineer District, ________

Attn: _____________________________

__________________________________

__________________________________

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