Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

OMB Control Number 2120-0746
Exp. 6/30/2014

Runway Safety Action Team Meeting Feedback
I attended a:



Local RSAT



Regional RSAT

Airport:
Date:
I am a: (check all that apply)

 Pilot
 Driver
 Controller

 Mechanic (taxi)
 Mechanic (tug/tow)
 Airport operations

Line / FBO employee
Wildlife control worker
Other

employee

Rating: 5-Strongly Agree 4-Agree 3-Neutral 2-Disagree 1-Strongly Disagree

Performance Item

Rating
(1-5)

Comments

I (or my organization) received
adequate notification of the RSAT
meeting.
I (or my organization) was
provided adequate opportunity to
express concerns and provide
input on runway safety issues.
I (or my organization) felt that the
RSAT meeting was well
organized and that relevant
information was shared with all
stakeholders.

Overall impression of the RSAT
meeting / general comments.

What is the ONE thing that would
have made this meeting better?
If you would like to be contacted by the Runway Safety office,
please send your feedback / questions in an email to [email protected]
When you have completed the form, please click the submit button to email it to our office.
Alternately, you may print the completed form and mail it to: Federal Aviation Administration, Office
of Runway Safety, 490 L'Enfant Plaza, Suite 7225, Washington, DC 20024 or FAX to 202-385-4772.
Paperwork Reduction Act Burden Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of
information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is
2120-0746. Public reporting for this collection of information is estimated to be approximately 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, AES-200.