Form 1 ANA Services Feedback Survey

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

ANA Services Survey-JCM

ANA Services Feedback Survey

OMB: 0970-0401

Document [doc]
Download: doc | pdf

ANA SERVICES SURVEY



  1. Have you accessed or utilized services of an ANA regional training and technical assistance (T/TA) provider?  Yes No Did not know ANA offered T/TA

    1. If so, which regional training and technical assistance provider?
      Eastern Western Alaska Pacific

b. If you used your regional T/TA center, generally how frequent were your interactions?

Daily Weekly Monthly Quarterly Yearly Never / N/A

  1. Did you access or utilize T/TA (click all that apply): During project planning and design? When writing and submitting your application? During project implementation? Other: _________________________?


  1. To what extent do you agree with the following statements?

The T/TA I received was helpful and effective.

Strongly disagree Disagree Neutral Agree Strongly agree N/A


The T/TA I received was instrumental in helping to build the capacity of our tribe/organization.

Strongly disagree Disagree Neutral Agree Strongly agree N/A


The T/TA I received was instrumental in helping to sustain our project.

Strongly disagree Disagree Neutral Agree Strongly agree N/A

  1. How would you rate your overall experience with ANA-provided T/TA?
    Poor Fair Average Good Excellent


Comments:      


  1. If you have any comments on a particular T/TA provider and/or a specific instance of T/TA, please include his or her name and your comments here (optional):      



  1. On a scale of 1 to 5, with 1 being poor and 5 being excellent, how would you rate your Program Specialist(s) in the following areas?

a. Responsiveness (e.g., responding to your phone calls/e-mails/other communication in a timely manner):
Poor Average Excellent

1 2 3 4 5

Comments:      

b. Ability to support you in meeting the federal grant requirements:

Poor Average Excellent

1 2 3 4 5

Comments:      


c. Ability to answer grant questions and provide assistance/provide suggestions and feedback to grantee (e.g., sharing knowledge and ideas, processing grant actions, information on additional resources on program specific issues):

Poor Average Excellent

1 2 3 4 5

Comments:      



  1. How would you rate your experience with or services received from the Office of Grants Management (OGM) during your current or most recent ANA project?

Poor Fair Average Good Excellent N/A

Comments:      

  1. Have you received an impact visit (for your current or most recent ANA grant)? Yes No If no, please go to question 7.


On a scale of 1 to 5, with 1 being poor and 5 being excellent, how would you rate your impact visit in the following areas?


  1. Communication prior to impact visit (e.g., providing you with information, responding to your phone calls/e-mails/other communication in a timely manner):
    Poor Average Excellent

1 2 3 4 5

Comments:      



  1. Ability to facilitate positive dialogue (e.g., culturally sensitive, listened well, demonstrated understanding of project):

Poor Average Excellent

1 2 3 4 5

Comments:      

  1. Which of the following types of communication from ANA were the most useful? (you may check more than one)


ANA website Grantee conference calls

Monthly email from your Program Specialist Quarterly newsletter

Other:       Webinars

    1. Comments: What additional resources, information, and/or topics would you like to see shared?      


    1. What would you like to see on the ANA website?      


  1. Was the Objective Work Plan (OWP) form a useful tool for guiding your project? Yes No

What, if any, changes would you make to the form?      



  1. Did the Objective Progress Report (OPR) aid you in monitoring your project? Yes No

What, if any, changes would you make to the form?      



  1. How would you rate your overall experience as an ANA grantee?

Poor Fair Average Good Excellent

    1. Comments (what did you like, what didn’t you like?):      





  1. Please comment if you have any suggestions on how to further improve ANA services.      

File Typeapplication/msword
AuthorDepartment of Health and Human Services
Last Modified ByDHHS
File Modified2013-03-28
File Created2013-03-28

© 2024 OMB.report | Privacy Policy