Evaluation Materials

OMB Control Number: 3170-XXXX
Expiration Date: XX/XX/XXXX

Instrument 2: Survey for Trainer Feedback on Curriculum Following
Usage with Case Managers
Respondents: Trainer Cohort Members
Collection Strategy: Paper Form
Thank you for completing this survey as part of our evaluation of this web-based training on
the FET Toolkit. Please note that the Bureau intends to keep your responses private to the extent
permitted by law, and when survey results are reported none of your answers will be connected
to you or your organization.

Please enter your name: _________________________________
Contextual Information
1) How many case managers participated in this training? ____________
2) In what city and state was the training held? ___________________________
3) What was the total duration of this training (excluding breaks)? ____________________
4) Describe the backgrounds of the case managers that participated in this training and the range of
the organizations for which they work.
__________________________________________________________________________________
Paperwork Reduction Act
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a valid OMB control
number. The OMB control number for this collection is 3170-XXXX. It expires on MM/DD/YYYY. The
time required to complete this information collection is estimated to average approximately 20
minutes per response, including the time for reviewing any instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. The obligation to respond to this collection of information is voluntary. Comments
regarding this collection of information, including the estimated response time, suggestions for
improving the usefulness of the information, or suggestions for reducing the burden to respond to
this collection should be submitted to Bureau at the Consumer Financial Protection Bureau
(Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to
[email protected].
.

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OMB Control Number: 3170-XXXX
Expiration Date: XX/XX/XXXX
__________________________________________________________________________________
5) Will the case managers you train usually be working with their clients face-to-face or by
telephone?
 Face-to-face
 By telephone
 Both face-to-face and by telephone
6) What types of services are clients generally seeking when they contact the case managers that
you will be training? (For example, are they looking for assistance with housing? Assistance with
health issues?, etc.)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Feedback on Toolkit Modules
In the following section of the survey, we would like you to describe your experiences and satisfaction
with each of the individual modules in the Financial Empowerment Toolkit. If you need additional space
for any of your answers, please use the back of the page.

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OMB Control Number: 3170-XXXX
Expiration Date: XX/XX/XXXX

Module

Module 1:
Introduction to
the Toolkit

On a scale of 1 to 5,
how useful do you
think these
resources will be to
the participants?

How many
minutes did
you spend
discussing
this module?

 5: Extremely useful
4
3
2
 1: Not at all useful

___________

What content in this
module will be most
useful for
participants?

What content or tools in
this module will be less
useful for participants, if
any, and why?

What feedback do you
have for how this module
should be revised?

 I did not
discuss this
module during
this training

Module 2:
Assessing the
Situation

 5: Extremely useful
4
3
2
 1: Not at all useful

___________
 I did not
discuss this
module during
this training

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OMB Control Number: 3170-XXXX
Expiration Date: XX/XX/XXXX

Module

Module 3:
Starting the
Conversation

On a scale of 1 to 5,
how useful do you
think these
resources will be to
the participants?

How many
minutes did
you spend
discussing
this module?

 5: Extremely useful
4
3
2
 1: Not at all useful

___________

What content in this
module will be most
useful for
participants?

What content or tools in
this module will be less
useful for participants, if
any, and why?

What feedback do you
have for how this module
should be revised?

 I did not
discuss this
module during
this training

Module 4:
Setting Goals

 5: Extremely useful
4
3
2
 1: Not at all useful

___________
 I did not
discuss this
module during
this training

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OMB Control Number: 3170-XXXX
Expiration Date: XX/XX/XXXX

Module

Module 5:
Saving for the
Unexpected,
Emergencies,
and Goals

Module 6:
Managing Cash
Flow

On a scale of 1 to 5,
how useful do you
think these
resources will be to
the participants?

How many
minutes did
you spend
discussing
this module?

 5: Extremely useful
4
3
2
 1: Not at all useful

___________

What content in this
module will be most
useful for
participants?

What content or tools in
this module will be less
useful for participants, if
any, and why?

What feedback do you
have for how this module
should be revised?

 I did not
discuss this
module during
this training

 5: Extremely useful
4
3
2
 1: Not at all useful

___________
 I did not
discuss this
module during
this training

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OMB Control Number: 3170-XXXX
Expiration Date: XX/XX/XXXX

Module

Module 7:
Dealing with
Debt

On a scale of 1 to 5,
how useful do you
think these
resources will be to
the participants?

How many
minutes did
you spend
discussing
this module?

 5: Extremely useful
4
3
2
 1: Not at all useful

___________

What content in this
module will be most
useful for
participants?

What content or tools in
this module will be less
useful for participants, if
any, and why?

What feedback do you
have for how this module
should be revised?

 I did not
discuss this
module during
this training

Module 8:
Understanding
Credit Reports
and Scores

 5: Extremely useful
4
3
2
 1: Not at all useful

___________
 I did not
discuss this
module during
this training

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OMB Control Number: 3170-XXXX
Expiration Date: XX/XX/XXXX

Module

Module 9:
Evaluating
Financial
Service
Providers,
Products, and
Services

Module 10:
Protecting
Consumer
Rights

On a scale of 1 to 5,
how useful do you
think these
resources will be to
the participants?

How many
minutes did
you spend
discussing
this module?

 5: Extremely useful
4
3
2
 1: Not at all useful

___________

What content in this
module will be most
useful for
participants?

What content or tools in
this module will be less
useful for participants, if
any, and why?

What feedback do you
have for how this module
should be revised?

 I did not
discuss this
module during
this training

 5: Extremely useful
4
3
2
 1: Not at all useful

___________
 I did not
discuss this
module during
this training

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Overall Reaction and Feedback
7) Is there anything that you did during this training that worked particularly well?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
8) Is there anything that you would do differently if you were to do this training again?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
9) Are there any topics that you believe should be covered in more detail in the Toolkit, or any
additional tools or resources that should be added?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
10) Thinking about the goal of equipping case managers to integrate financial empowerment into
their work, please provide any other suggestions you have for how the Toolkit could be improved.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

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