Form FEMA Form 007-0-3 FEMA Form 007-0-3 Registration Survey - Phone

Registration Survey

OMB Control Number 1660-0036

Expiration Date 02/28/2014

PAPERWORK BURDEN DISCLOSURE NOTICE: Public reporting burden for this survey is estimated to average 6 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the survey. You are not required to respond to this collection of information unless it displays a valid OMB control number near the title of the electronic collection instrument, or for on-line applications, on the first screen viewed by the respondents. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0036) NOTE: Do not send your completed form to this address.

The following survey is voluntary.

PRIVACY ACT STATEMENT

AUTHORITY: Government Performance and Results Act (GPRA), 5 U.S.C. Ch. 3 as amended and the GPRA of 2010 (P.L. 111-352); Executive Order (EO) 12862, “Setting Customer Service Standards;” and its March 23, 1995 Memorandum addendum, “Improving Customer Service;” Executive Order 13411 “Improving Assistance for Disaster Victims;” Executive Order 13571 “Streamlining Service Delivery and Improving Customer Service;” and its June 13, 2011 Memorandum “Implementing Executive Order 13571 on Streamlining Service Delivery and Improving Customer Service.”

PRINCIPAL PURPOSE(S): DHS/FEMA collects this information to measure Individual Assistance customers’ satisfaction with FEMA services.

ROUTINE USE(S): This information is used for the principal purpose(s) noted above and will not be shared outside of DHS/FEMA, except as allowed under DHS/FEMA-008 - Disaster Recovery Assistance Files (April 30, 2013, 78 FR 25282), or as required by law.

DISCLOSURE: The disclosure of information on this form is strictly voluntary and will assist FEMA is making improvements to its Individual Assistance program; failure to provide the information requested will not impact the provision of FEMA Individual Assistance to qualified entities.

QUESTIONS

Introduction

Hello, I’m calling from FEMA, the Federal Emergency Management Agency. My name is ___. My ID # is _________. May I please speak with (Applicant) or the person who registered for FEMA assistance?

• Yes

• No

If no: What would be a better time to call back? Thank you for your time and have a good day/evening.

If yes: We're looking for ways to improve the quality of our service and your opinion is very important to us. Do you remember speaking with (Agent) when you registered?

• Yes

• No

If no: Thank you for your time and have a good day/evening.

If yes: Would you volunteer to take 3-7 minutes to answer some questions?

• Yes

• No

If no: What would be a better time to call back? Thank you for your time and have a good day/evening.

If yes: Thank you. These questions comply with the Privacy Act of 1974 and have been approved by the Office of Management and Budget under number 1660-0036. Your answers will not affect the outcome of your application for FEMA assistance. This call may be monitored and/or recorded for quality assurance.

Let's start with questions related to your conversation with [agent], who assisted you in registering for FEMA disaster assistance.

1. Using a rating scale of Excellent, Good, Satisfactory, Below Average or Poor, how would you rate him/her on showing an interest in helping you?

If Below Average or Poor go to question 1a else go to question 2.

1a. What made you feel he/she was not interested in helping?

• Didn’t Answer My Question(s)

• Didn’t Listen

• Didn’t make Me Eligible

• Minimized my losses

• No Empathy

• Rushed Call/Contact

• Other

2. How would you rate him/her on being courteous?

• Excellent

• Good

• Satisfactory

• Below Average

• Poor

If Below Average or Poor go to question 2a, otherwise go to question 3.

2a. In what way was he/she not courteous?

• Accusatory

• Agent wasn’t Knowledgeable

• Condescending

• Didn’t Answer My Questions

• Impatient

• Interrupted

• No Empathy

• Rude

• Tone of voice

• Other

Now thinking about the information [Agent] provided during the registration,

3. How would you rate him/her on explaining information so it was easy to understand?

• Excellent

• Good

• Satisfactory

• Below Average

• Poor

If Below Average of Poor go to question 3a, if Excellent go to question 3b otherwise go to 4.

3a. What did he/she do that made the information difficult to understand?

• Agent Wasn’t Knowledgeable

• Didn’t Answer Questions

• Inconsistent Information

• Jargon/Terminology

• No Empathy

• Speech Unclear

• Talked too Fast

• Too Complicated

• Rude

• Other

Go to 4.

3b. What specifically did he/she do to help you understand the information?

• Answered Questions

• Asked if I Understood

• Explained Details

• Patient

• Repeated Information

• Used Easy to Understand Terminology

• Other

4. How would you rate him/her on letting you know what you needed to do next?

• Excellent

• Good

• Satisfactory

• Below Average

• Poor

If Below Average or Poor go to question 4a otherwise go to question 5.

4a. In what way was he/she [Below Average/Poor] in letting you know what you needed to do next?

• Agent wasn’t Knowledgeable

• Didn’t answer my Questions

• Next Steps not Given

• Rushed/No time to Write information

• Too Confusing

• Too much Information

• Other

5. Overall, would you say the level of customer service provided by [Agent] was Excellent, Good, Satisfactory, Below Average or Poor?

If Satisfactory, Below Average or Poor go to question 5a otherwise go to question 7.

5a. What specifically could he/she have done better?

• Be More Accurate

• Be More Clear

• Be More Caring/Empathetic

• Have more Patience

• Provide More Details

• Use Plain Language

• Other

If registration type flag indicates a face to face contact go to Q6 else go to Q7.

6. Did the face to face meeting with [Agent] take place:

• In your home

• At a business

• At your work place

• On the street

• In a shelter

• At a local meeting place such as a church, town hall, school etc.

• At a Disaster Recovery Center

• Other

• Did not meet face to face

If response = Did not meet face to face to Q7 else go to 6a

6a. If you needed assistance with temporary housing how would you rate [Agent] in helping you with housing resources? Would you say:

• Extremely Helpful

• Very Helpful

• Helpful

• Not Very Helpful

• Not at all Helpful

• Did not need temporary housing

If response = Not Very Helpful or Not at all Helpful go to Q6b else go to q 6c

6b. In what way could they have been more helpful in assisting with housing resources? (Text Box)

6c. If the representative provided you with information about other agencies or organizations how helpful was that information? Would you say:

• Extremely Helpful

• Very Helpful

• Helpful

• Not Very Helpful

• Not at all Helpful

• Information not needed/provided

If response = Not Very Helpful or Not at all Helpful go to Q6d else go to q 6e

6d. In what way could the information about other agencies or organizations have been more helpful? (Text Box)

6e. Did you have any needs that were not addressed by the representative?

• Yes

• No

• Don’t Know/Remember

If response = Yes go to 6f else go to 6g)

6f. What specific needs were not addressed? (Text Box)

6g. What did you like most about being able to meet face to face with the FEMA representative?

(Text Box)

6h. What did you like least about being able to meet face to face with the FEMA representative?

(Text Box)

6i. What suggestions do you have for FEMA on better ways to assist disaster survivors?

(Text Box)

The next questions are about the Internet On-line Registration available at the FEMA.gov and DisasterAssistance.gov websites.

7. Did you try to register for FEMA Disaster Assistance over the Internet?

• Yes

• No

• Don't Remember

If No go to question Q7a if Yes go to Q7b else go to Q8

7a. What were your reasons for not using the internet to register?

• Computer Damaged

• Didn't Know I Could

• Limited Computer Skills

• No Computer

• No Internet Access

• Preferred to Talk to FEMA

• Security Concerns

• Utilities Out

• Website not Accessible

• Other

7b. What are the reasons you were unable to complete your registration over the Internet?

• Browser Issues

• Info Needed not Available

• Instructions Unclear

• Navigation Issues

• Preferred to Talk to FEMA

• Registered on Phone Also

• Security Concerns

• Security Screen Characters

• Slow Internet Response Time

• Technical Problems

• Too Complicated/Difficult

• Took too Long

• Website not Accessible

• Other

If response = Browser Issues, Slow Internet Response Time, Navigation Issues, Technical Problems, Website not Accessible or Security Screen Characters go to Q7c else go to 8.

7c. When attempting to register were you using a mobile device such as an internet-enabled smartphone?

• Yes

• No

• Don’t Know/Remember

8. Shortly after the disaster was declared, information was made available about FEMA’s programs and how to register. What were your main sources for FEMA disaster assistance information?

• Community Group (club, church, school, etc.)

• Disaster Workers (ARC, Local Gov., etc.)

• FEMA Disaster Worker

• FEMA website

• Flyers, Signs, Billboards, Posters, etc.

• Internet searches (Google, Bing, etc.)

• Newspaper

• Prior Experience

• Radio

• Service Provider (Insurance, water, gas, phone, etc.)

• Social Media (Facebook, Twitter, etc.)

• Television

• Text, Phone, Email Alerts (reverse 911, robo call, RSS Feed, etc.)

• Word of Mouth (friend, family, neighbor, employer, landlord etc.)

• Other

If response = FEMA website go to Q8a else go to Q9.

8a. Would you say the information provided through the FEMA website was Very helpful, Helpful, Not very helpful.

If response = Not very helpful go to 8b else go to Q9.

8b. What could be changed to make FEMA website information more helpful?

For the next question please think about the general process of applying for disaster assistance.

9. Overall, would you say FEMA’s disaster assistance application process was…

• Excellent

• Good

• Satisfactory

• Below Average

• Poor

• Don’t know/No Opinion

If Below Average or Poor go to 9a otherwise go to 10.

9a. In what way was it (Below Average/Poor)? (Text Box)

10. Your opinion is very valuable to us, May we call at a later date to ask some additional questions?

• Yes

• No.

Closing

Thank you for your time. Have a good day/evening.

FEMA Form 007-0-3 8