Survey - Section 504 Self-Evaluation Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Fast Track)

Survey-Sec 504 Self-Eval Survey

Survey - Section 504 Self-Evaluation Survey

OMB: 0960-0788

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Section 504 Webinar Survey on Providing Feedback for Individuals with Mental or Cognitive Impairments


  1. How can we improve the following ways we communicate with individuals who have mental or cognitive impairments when we are communicating with them:

    1. Face to face

____________________________________________________________________________________________________________________________________________________________________________________

    1. Over the Internet

_____________________________________________________________________________________________________________________________________________________________________________________________

    1. By telephone

_____________________________________________________________________________________________________________________________________________________________________________________________

    1. In our printed materials

_____________________________________________________________________________________________________________________________________________________________________________________________


  1. How can we improve our policies so that we effectively communicate with individuals who have mental or cognitive impairments?

______________________________________________________________________________________________________________________________________________________________________________________________________


  1. Please tell us about national organizations that provide communication assistance free of charge to individuals with mental or cognitive impairments.

______________________________________________________________________________________________________________________________________________________________________________________________________

  1. Do you think there should be additional webinars regarding Section 504?

    1. If so, on what topic(s) would you like to see a future webinar?

____________________________________________________________________________________________________________________________________________________________________________________

    1. If not, is there a better way for you to share information with us?

____________________________________________________________________________________________________________________________________________________________________________________

  1. How would you rate the following aspects of the webcast?

    1. Use of a webcast to present this type of information?

Excellent, good, fair, poor


    1. Overall value of the webcast to you?

Excellent, good, fair, poor


    1. Clarity of information provided?

Excellent, good, fair, poor


OMB Number: 0960-0788

Paperwork Reduction Act Statement

This information collection meets the clearance requirements of 44 U.S.C. § 3507, as amended by Section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. You may send comments on our time estimate to SSA, 6401 Security Blvd., Baltimore, MD 21235-6401.


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File Typeapplication/msword
File TitleAppendix A
Author889123
Last Modified By889123
File Modified2012-03-09
File Created2012-03-09

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