Meeting/Forum Evaluation

Office of Surface Mining Reclamation and Enforcement

Meeting/Forum Evaluation

OMB 1029-0114

Expires 05/31/2014

Thank you for participating in this meeting/forum presented by the Office of Surface Mining Reclamation and Enforcement. Your response to this survey will assist us in evaluating and improving our performance as required by the Government Performance and Results Act. Your response is voluntary.

OSMRE Use Only

MEETING/FORUM TITLE: Put Meeting/Forum Title Here Before Sending

MEETING/FORUM DATE: Put Date Here Before Sending

(Please Circle: 1=Very Dissatisfied 2=Dissatisfied 3=Neutral 4=Satisfied 5= Very Satisfied

Please rate your overall satisfaction with the meeting/forum: 1 2 3 4 5

Which topics/sessions were the most useful to you?

Are there additional topics or speakers that should have been included?

Do you have topic suggestions for future meeting/forums?

How could the format be improved?

Do you have other comments about the meeting/forum?

Please rate your overall satisfaction with the facilities: 1 2 3 4 5

Comments about the facilities:

Comments about the accommodations (if provided by OSMRE):

Return this evaluation form by email or print the form and mail or fax to:

Office of Surface Mining Reclamation and Enforcement E-Mail: @osmre.gov

(Organization Name) Fax:

(Organization Address)

PAPERWORK REDUCTION ACT STATEMENT

The Paperwork Reduction Act of 1995 (44 U.S.C. 3501) requires us to inform you that: Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. This information is being collected to better serve you in the future and as part of the Office of Surface Mining Reclamation and Enforcement's performance of its responsibilities under the Government Performance and Results Act. Your response is voluntary.

Public reporting burden for this form is estimated to average five minutes per response, including time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, Room 203 SIB, 1951 Constitution Ave, NW, Washington, D.C. 20240.