Form TTB F 5700.04 TTB F 5700.04 NRC Survey - Claimants

OMB NO. 1513-0124 (08/31/2013)
DEPARTMENT OF THE TREASURY – ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

NRC SURVEY - CLAIMANTS
According to the Paperwork Reduction Act of 1995, no persons are 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 1513-0124.
Specialist/Clerks Name

Registry/Reference Number

Industry Member Owners Name

Permit/FAM Number

Person being Interviewed

(Rate on a scale of 1 to 5 with 1 being least satisfied and 5 being most satisfied. Answer ‘N/A’ if question does not apply.)

1. How satisfied were you with the ease of obtaining the appropriate claim form(s)?
2. How satisfied were you with the ease of understanding the claim form instructions?
3. How reasonable was the information we asked you to provide?
4. How satisfied were you with the acknowledgement that we received your claim?
5. Did you contact the specialist working on your claim? (If ‘yes’ ask question 6a)
5a. How satisfied were you with the ease of contacting the specialist working on your claim?
5b. How satisfied were you with the technical knowledge of your specialist?
5c. How satisfied were you with the courtesy and professionalism of your specialist?
5d. How satisfied were you with the ability of your specialist to resolve issues?
5e. How satisfied were you with your specialist in keeping you up-to-date on the status of your
claim?
6. How satisfied were you with the length of the claim filing process from start to finish?
7. How satisfied were you with the explanations in the notification of the final action on your claim?
8. How satisfied were you with the amount of time you had to spend on the claim filing process?
9. How satisfied were you with the fairness of treatment by the Bureau in deciding the final action
taken on your claim?
10. How satisfied were you with the overall way your claim was handled?
TTB F 5700.04 (03/2012)