Ticket to Work (TTY) Work Incentives Seminar Event (WISE) Survey

OMB Control No. 0960-0526

Expiration Date: August 2012

Online National WISE Webinar: Pre- and Post-Webinar Survey Questions

Thank you for attending today’s (“registering for the” if we’re able to provide polling questions w/ registration confirmation) national WISE webinar; we hope you find the information helpful in your journey to employment!

Before we begin, (omit “before we begin” if we’re able to provide polling questions w/ registration confirmation) please take a minute to answer the following questions.

1. How did you learn about this national WISE webinar?

• E-mail

• Facebook/Twitter

• Website

• Friend/family

• WIPA

• Other [COMMENT BOX]

2. What do you hope to learn from the national WISE webinar? (Check all that apply)

• Ticket to Work

• Work Incentives for SSI

• Work Incentives for SSDI

• Employment Networks/Vocational Rehabilitation

• Legal Protection & Advocacy

• Other [COMMENT BOX]

3. What is your gender?

• Male

• Female

4. What is your age?

• 18 or younger

• 19-25

• 26-40

• 41-55

• 56-65

• 66 or older

5. How many others participated in the national WISE webinar with you (Do not include yourself)?

• 0

• 1

• 2

• 3

• 4

• 5 or more

• continued -

Thank you for attending today’s national WISE webinar; we hope you found the information helpful! Please let us know how we can improve the WISE webinar so we can offer the best possible support to people with disabilities go to work.

Please choose the number that best describes your national WISE webinar experience.

1 = Strongly Disagree 5 = Strongly Agree

1. I know more about Ticket to Work 1 2 3 4 5 N/A

Comments: [COMMENT BOX]

2. I know more about Work Incentives 1 2 3 4 5 N/A

Comments: [COMMENT BOX]

3. I plan to contact an Employment Network 1 2 3 4 5 N/A

Comments: [COMMENT BOX]

4. I plan to contact a Vocational Rehabilitation Agency 1 2 3 4 5 N/A

Comments: [COMMENT BOX]

5. I plan to contact a WIPA 1 2 3 4 5 N/A

Comments: [COMMENT BOX]

6. The presenters were well-prepared and organized 1 2 3 4 5 N/A

Comments: [COMMENT BOX]

7. The presenters were easy to understand 1 2 3 4 5 N/A

Comments: [COMMENT BOX]

8. This webinar met my accessibility needs 1 2 3 4 5 N/A

Comments: [COMMENT BOX]

Paperwork Reduction Act Statement

Paperwork Reduction Act Statement – This information collection meets the requirements of 44 U.S.C. §3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 5 minutes to complete this survey. You may send comments on our time estimate above: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address.