Technical Assistance Evaluation

Office of Surface Mining Reclamation and Enforcement
Technical Assistance Evaluation

OMB 1029-0114
Expires 03/31/2011

The Office of Surface Mining Reclamation and Enforcement recently provided technical assistance for the project or activity listed below. Your
response to this survey will assist us in evaluating and improving our performance as required by the Government Performance and Results Act. Your
response is voluntary.
OSMRE Use Only

Project Title:
Provided for:
Completion Date:
Assistance for Regulatory Program?
Assistance for Abandoned Mined Lands Program?
Assistance Provided By:
Type of assistance:

On-the-job-training

Technical Assistance

Number of people assisted:

1.

Was the assistance timely? (1 very untimely - 5 very timely)

2.

Was the assistance professional and of high quality? (1 very low - 5 very high)

3.

Were the assistance objectives met? (1 very little met - 5 extremely well met)

4.

Were you satisified with the assistance? (1 very unsatisfied - 5 very satisfied)

5.

Please comment about the assistance:

Return this evaluation form by pressing the "Submit by Email” button or; print the form and mail or fax to:

Print Form

Office of Surface Mining Reclamation and Enforcement
Technology Management Division
1999 Broadway, Suite 3320
Denver, CO 80202-3050

Submit by Email

Fax (303) 293-5058

PAPERWORK REDUCTION ACT STATEMENT
The Paperwork Reduction Act of 1995 (44 U.S.C. 3501) requires us to inform you that: Federal Agencies 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. This information being collected to better serve you in the future and as part of the Office of Surface Mining Reclamation and Enforcement's performance of its responsibilities under
the Government Performance and Results Act. Your response is voluntary.
Public reporting burden for this form is estimated to average five minutes per response, including time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments
regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, Room 202 SIB, 1951 Constitution Ave, NW,
Washington, D.C. 20240.