Individuals and Households

U.S. Department of Agriculture

Food and Nutrition Service

An Assessment of the Roles and Effectiveness of

Community-Based Organizations in the

Supplemental Nutrition Assistance Program

Project Officer: Rosemarie Downer

Attachment C

January 9, 2012

OMB Control Number: 0584-XXXX
Expiration Date: XX/XX/XXXX

Attachment C:
client satisfaction survey

SECTION A: BASIC INFORMATION ABOUT THE APPLICATION EXPERIENCE

1. There are a few ways people can apply for food stamps, which are also called SNAP benefits. For example, some people go to a government social services office to apply. Other people apply with the help of a community organization. How did you apply for your current SNAP benefits?

PROBE: Was it:

1. [STATE AGENCY/SNAP OFFICE]  SKIP TO 3

2. [CBO]

3. [DON’T READ]: Online SKIP TO 7

4. [DON’T READ]: Don’t KnowSKIP TO 7

2. Why did you choose this location? [INTERVIEWER CODES RESPONSES]

   1. You didn’t know there was another way to apply

   2. You go there for other services

   3. You feel comfortable going there

   4. It is conveniently located / close to your home

   5. It has convenient hours of operation

   6. You don’t have to wait a long time

   7. The people who work there are friendly

   8. The people who work there speak my language

   9. Someone referred me there

3. Did anyone from [FILL FROM 1] assist you in filling out the application?

1. Yes

2. No GO TO 7

4. How helpful was their assistance? Would you say it was:

1. Extremely helpful

b. Moderately helpful

c. Not at all helpful

5. Did you have to wait for their assistance?

   1. Yes

   2. No GO TO 7

6. How long did you have to wait? [INTERVIEWER CODE]

   1. Less than 15 minutes

   2. Between 15 and 30 minutes

   3. More than 30 minutes but less than an hour

   4. More than an hour

7. Have you started receiving your food stamp benefits yet?

   1. Yes

   2. No GO TO 9

8. According to our records, you applied on [insert date]. About how long after you applied did it take to get your food stamp benefits?

   1. Less than a week

   2. 1-2 weeks

   3. 3-4 weeks

   4. More than a month

9. Was this the first time you ever applied for food stamps?

1. Yes GO TO SECTION B

2. No

10. Where did you apply for food stamps the previous time? Was it:

    1. Through a State Agency/Social Services Office

    2. Through a community organization

    3. Other (specify________________)

11. Thinking about your most recent experience applying for food stamps, how did it compare to your previous experience? Was it easier to apply this time, harder or about the same?

    1. Easier to apply this time

    2. Harder to apply this time

    3. About the same

SECTION B: SNAP ELIGIBILITY INTERVIEW

Now I’d like to talk about your SNAP interview. This is when you are asked questions about your household and your sources of income, to find out if you are eligible for food stamps and how much your benefits should be.

12. Did your interview take place by phone or in person?

    1. In person

    2. By phoneGO TO 17

13. Where was the interview conducted?

INTERVIEWER CODE:

1. SNAP office

2. My home

3. CBO office or headquarters

4. Food bank or pantry

5. Library

6. School

7. Senior center or community center

8. Church

9. Other; Please specify: ______________

14. How convenient for you was the location where your interview took place? Would you say it was:

    1. Very convenient

    2. Somewhat convenient

    3. Somewhat inconvenient, or

    4. Very inconvenient

15. Did you feel like this location offered you enough privacy?

    1. Yes

    2. No

16. Sometimes applicants are interviewed right when they apply, and other times they need to wait for an interview. What was your experience? Were you interviewed when you applied, or did your interview take place later?

    1. Interviewed right away GO TO 19

    2. Interviewed later

17. How long did you have to wait for an interview after applying?

[INTERVIEWER FILL]

18. Was the interview scheduled for a time that was convenient for you?

    1. Yes

    2. No

19. In what language was your interview conducted?

1. English

2. Spanish

3. Other; Please specify:_______________________________

20. Was this the language you felt most comfortable using for your interview?

    1. Yes

    2. No

SECTION C: OVERALL SATISFACTION WITH CBO

[QUESTIONS 21, 22 AND 23 FOR CBO INTERVIEWED PARTICIPANTS ONLY]

The next few questions ask about your overall experience and satisfaction with [CBO].

I am going to read you some general statements about [FILL CBO]. After each statement, please tell me how much you agree or disagree with the statement, by choosing strongly agree, agree, disagree, or strongly disagree.

21. The staff at [FILL CBO] were very knowledgeable about SNAP, SNAP eligibility and the application procedures.

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

22. It was difficult to find someone at [FILL CBO] who was available to help me apply for SNAP.

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

23. When I had questions about SNAP and how to apply, the staff I spoke with at [FILL CBO] were able to provide clear answers to my questions.

    1. Strongly agree

    2. Agree

    3. Disagree

    4. Strongly disagree

For each of the following questions, please rate your satisfaction, by saying you were very satisfied, satisfied, dissatisfied or very dissatisfied. Please answer as best you can.

24. Thinking again about your SNAP interview, how satisfied were you with [STATE AGENCY or CBO]’s overall procedures for scheduling and conducting your interview? Were you:

    1. Very Satisfied

    2. Satisfied

    3. Dissatisfied

    4. Very Dissatisfied

25. How satisfied were you with [STATE AGENCY or CBO]’s overall customer service? Were you:

    1. Very Satisfied

    2. Satisfied

    3. Dissatisfied

    4. Very Dissatisfied

26. How satisfied were you with how long it took to receive your benefits?

Were you:

1. Very Satisfied

2. Satisfied

3. Dissatisfied

4. Very Dissatisfied

SECTION D: OPEN-ENDED QUESTION

27. Is there anything else you’d like to tell me, in your own words, about your experience applying for SNAP at [FILL STATE AGENCY OR CBO NAME]?

Thank you for taking this survey!

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection