Form 0970-0303 Appendix T_Customer Services Information Questions

Public reporting burden for this collection of information is estimated to be 1 minute per response to complete this questionnaire. 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. The control number for this project is 0970-0303. The control number expires on XX/XX/XXX.

Customer Services

Information Questions

1. Which of the following best describes why you are visiting Child Welfare Information Gateway and your background or role in the child welfare field? (Check one)

• I am looking for information to help me in my work (please indicate your professional affiliation below):

  1. Adoption in a private agency

  2. Adoption in a public agency

  3. Child abuse prevention/family support

  4. Child welfare in a private agency

  5. Child welfare in a public agency

  6. Legal or law enforcement

  7. Media or library

  8. Health/Mental Health

  9. Researcher/Evaluator

  10. Teacher—K-12

  11. Faculty – Higher Education

  12. Other: ___________________________________

• I am looking for information to help me with my schoolwork/coursework (please indicate level below):

  1. Student—K-12

  2. Undergraduate

  3. Postgraduate

  4. Other: ___________________________________

• None of the above – I am looking for information to help me with a personal situation. I am a(n):

  1. Adopted person

  2. Adoptive parent

  3. Birth parent

  4. Birth relative

  5. Prospective adoptive parent

  6. Foster parent/legal guardian

  7. Other: ___________________________________

2. In which State/territory is your work geographically located? (drop down list)_____________