Site Recertification Survey

SITE RECERTIFICATION SURVEY

FEMA Form 007-0-18

OMB No.: 1660-0036

Expires:

Public reporting burden for this survey is estimated to average 15 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the survey. You are not required to respond to this collection of information unless it displays a valid OMB control number near the title of the electronic collection instrument, or for on-line applications, on the first screen viewed by the respondents. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0036) NOTE: Do not send your completed form to this address. The following survey is voluntary.

Hello, I’m calling from FEMA, the Federal Emergency Management Agency. My name is _____. My ID # is _______. May I please speak with ____________________ (contact name) or another person who met with the FEMA Housing Representative on <_____>(date)?

If no: Thank you for your time and have a good day/evening. (Mark attempt)

If yes: We're looking for ways to improve the quality of our service and your opinion is very important to us.

Would you volunteer to take 7 - 9 minutes to answer some questions?

• No (if no) I understand, Thank you for your time and have a nice day/evening)

• Yes (if yes) Thank you. The following questions have been approved by the Office of Management and Budget under number 1660-0036. Please be assured your answers will not affect the outcome of your application for FEMA assistance.

SITE RECERT PROCESS OVERALL
Question		Response Options
A FEMA representative recently met with you to discuss your need for additional rental assistance. We would like to get your opinion about that meeting. Q1. Please rate the process of being considered for additional rental assistance. Would you say it’s been... (READ list) (If below average or poor, go to 1a, otherwise go to #2)		Excellent Good Satisfactory Below average Poor (DO NOT read) Don’t know / No opinion
1a. In what way has the process been less than satisfactory for you? (DO NOT read list. Mark all that apply.)		Didn’t receive any/enough assistance Poor attitude Process too complicated/too long Didn’t explain programs clearly or could not answer my questions Didn’t seem interested in helping me Didn’t take time to listen to me Took too long to answer questions Took too long to process Didn’t treat me with respect Other (text box here)

FEMA HOUSING REPRESENTATIVE – ATTRIBUTE SERIES
2. This next series of questions is about the representative who visited with you.
1. Using a scale of Excellent, Good, Satisfactory, Below Average or Poor, how would you rate [the Representative] on showing an interest in helping you? READ scale if necessary:		Excellent Good Satisfactory Below Average Poor Don’t know / No opinion
(If Answer is Below Average or Poor, go to Q1a) 1a. What made you feel that [he/she or Representative’s name] was not Interested in Helping you? (DO NOT read list. Mark all that apply.)		Rushed through visit Didn’t answer questions I had to repeat my questions Didn’t express empathy Didn’t make me eligible OTHER (specify)

2. How would you rate him/her on providing information in an easy to understand manner? Would you say he/she was… READ scale:	Excellent Good Satisfactory Below Average Poor Don’t know / No opinion
(If Answer is Below Average or Poor, go to Q2a) 2a. In what way was he/she below average or poor?	Used government jargon Sounded like a script Spoke too fast Terms hard to understand OTHER (specify)

3. How would you rate him/her on being courteous? READ statement and scale as necessary:	Excellent Good Satisfactory Below Average Poor Don’t know / No opinion
(If below average or poor, go to 3a) 3a. In what way was he/she not courteous?	Spoke too fast Tone of voice Condescending Accusatory Impatient OTHER (specify)

4. How would you rate (him/her) on letting you know what you needed to do next?	Excellent Good Satisfactory Below Average Poor Don’t know / No opinion
(If below average or poor go to 4a.) 4a. In what way was it below average or poor? (DO NOT read list. Mark all that apply.)	Information was not clear Next steps not given Too much information Not enough time to write it down Didn’t answer my questions Other (specify)

5. How effective was he/she in resolving your issues?	Extremely Effective Very Effective Somewhat Effective Not Very Effective Not At All Effective I had no issues
(If not very or not at all effective, go to 5a.) 5a. In what way was (he/she) not effective?	Inconsistent information Didn’t answer my questions Did not trust repre. would take action No confidence in information Took too long Other (specify)

6. What was your overall impression of the customer service provided by [ Representative’s Name ]?	Excellent Good Satisfactory Below Average Poor Don’t Know / No Opinion
(If below average or poor, go to 5a.) 6a. What could she/he have done better?	Enter in text box as stated by applicant.

RECERTIFICATION SITE VISIT SERIES
Question		Response Options
3. Before the meeting with the representative, did you have adequate time to assemble the necessary documents? (If “Yes”, go to 3b, otherwise go to 3a)		Yes (all) No (some or none)
3a. Did you need help from the Housing Representative to gather the documents during your meeting?		Yes No
3b. During the meeting, you and [Rep’s name/the Representative] reviewed a form called “Declaration of Continuing Need”. How would you rate [Rep’s name/the Representative’s] explanation of that form? (READ list.)		Excellent Good Satisfactory Below average Poor □ (DO NOT read) Don’t know / No opinion

3c. How would you rate [him/her] on explaining how to develop a housing plan? (Read list AS NEEDED)	Excellent Good Satisfactory Below average Poor (DO NOT read) Don’t know / No opinion
3d. How would you rate [him/her] on explaining your current and pre-disaster monthly housing costs? (Read list AS NEEDED)	Excellent Good Satisfactory Below average Poor (DO NOT read) Don’t know / No opinion

3e. How would you rate [his/her] explanation of the process for submitting your documents? (Read list AS NEEDED)	Excellent Good Satisfactory Below average Poor (DO NOT read) Don’t know / No opinion
3f. How would you rate his/her explanation of household income?” (Read list AS NEEDED)	Excellent Good Satisfactory Below average Poor (DO NOT read) Don’t know / No opinion
3g. How would you rate [Rep’s name/the Representative] on explaining the lease agreement? (Read list AS NEEDED)	Excellent Good Satisfactory Below average Poor (DO NOT read) Don’t know / No opinion
3h. How would you rate the explanation of the required rent receipts and landlord information? (Read list AS NEEDED)	Excellent Good Satisfactory Below average Poor (DO NOT read) Don’t know / No opinion

TIMING OF VISIT
Question		Response Options
4. Did [Rep’s name/the Representative] arrive for your appointment ... (READ list) (If “Too early” or “Too late”, go to Q4a.)		Too early On time Too late (DO NOT read) Don’t know / No opinion
4a. Did he/she call ahead to let you know about the change of time for your appointment? (DO NOT read list.)		Yes No Don’t know / No opinion

4b. How would you rate the convenience of your appointment time? (READ list)

Excellent Good Satisfactory Below average Poor (DO NOT read) Don’t know / No opinion

SUGGESTIONS TO IMPROVE
Question		Response Options
5. Suggestion. FEMA is interested in getting your opinion on what we could do to improve our service. What other suggestions would you like to pass on to FEMA about site recertification that you haven’t already shared?		Open-ended Question Text box here ________________________________________________________________________________________________________________________________________________________

CALL BACK
Question		Response Options
6. Your opinion is very valuable to us, may we call you at a later date to ask you some additional questions?		Yes No

CLOSING
Yes (If “yes”) Thank you very much for time. Have a good day/evening.
No (If “no”) I understand. Thank you very much for your time. Have a good day/evening.

FEMA Form 007-0-18 Page 9 of 9