Women, Infants and Children Overseas Participant Satisfaction Survey

Form Approved

OMB No. 0720-0046

DateTBD

Women, Infants and Children Overseas Program (Please indicate your response by placing a check mark (√) in the applicable box)	Strongly Agree		Agree	Neither Agree nor Disagree	Disagree	Strongly Disagree
1. I was able to reach the WIC Overseas Office by phone easily.
2. I located the WIC Overseas office without difficulty.
3. My appointment was conducted in a private environment.
4. The staff was courteous.
5. The staff was able to answer my questions to my satisfaction.
6. I understood how to use the drafts upon leaving my appointment.
7. I am using the nutritional and health information I received to improve my family’s health.
8. I would recommend the WIC Overseas Program to a friend or relative.
9. If you have participated in the WIC Program in the United States, how does the WIC Overseas Program compare? WIC Overseas is:  Better  Same  Worse  Did not participate in WIC in the United States 10. How satisfied are you with the WIC Overseas Program?  Very Satisfied  Satisfied  Somewhat Satisfied  Dissatisfied  Very Dissatisfied 11. Comments: (Please do not include Personally Identifiable Information) __________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________

WOMEN, INFANTS and CHILDREN OVERSEAS PARTICIPANT SATISFACTION SURVEY

Please take a few minutes to complete this survey. Participation in the survey is voluntary.

Your feedback is an important part of our ongoing efforts to

Thank You!

make the WIC Overseas Program a

successful community program. Your responses will be treated anonymously.

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information is estimated to average 15 minutes per survey, including the time for reviewing instructions, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100 (0720-0046). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.