Form 10-1500197(WS) CSPCC Study Chairperson and NSC Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

CSPCC Study Chairperson and NSC Survey - complete with cover 122315

Cooperative Studies Program

OMB: 2900-0770

Document [docx]
Download: docx | pdf






Cooperative Studies Program Coordinating Centers (CSPCC) Study Chairperson and

National Study Coordinator (NSC)

Satisfaction Survey

OMB No. 2900-0770
Estimated Burden: 5 mins

Expiration Date: 08/31/2017









The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 5 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this telephone/mail survey will lead to improvements in the quality of service delivery by helping to improve customer services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.



VA Form 10-1500197(WS)
NOV 2015



Title of person completing the survey

  1. Study Chair

  2. National Study Coordinator


  • Study Number:


  • I have worked on this study for 1 year or more

  1. Yes

  2. No


  • Cooperative Studies Program Coordinating Center (CSPCC) service that this survey is based on

  1. Boston CSPCC

  2. Hines CSPCC

  3. Palo Alto CSPCC

  4. Perry Point CSPCC

  5. West Haven CSPCC


Part 1 – Overall Satisfaction with the Quality of Services Received


  1. I am satisfied with the quality of services provided.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


Part 2 – Accessibility and Responsiveness


  1. I am satisfied with the quality of the study materials (reports, data manuals, etc.) provided by CSPCC.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. The CSPCC is timely in providing updated study information.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. The CSPCC clearly communicates issues regarding study sites.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. The CSPCC provides study reports needed to determine the needs of the sites.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. The CSPCC is committed to treating its partners with respect.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. I am satisfied with the accessibility and responsiveness of the coordinating center when I need to reach them.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


    • If your answer is “strongly disagree” or “disagree,” select all staff who were not accessible.

      • Biostatistician

      • Project Manager

      • Data Coordinator


  1. I am satisfied with the promptness of the coordinating center staff when returning phone calls.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


    • If your answer is “strongly disagree” or “disagree,” select all staff who were not accessible.

      1. Biostatistician

      2. Project Manager

      3. Data Coordinator


  1. I am satisfied with the promptness of coordinating center staff when responding to email

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


    • If your answer is “strongly disagree” or “disagree,” select all staff who were not accessible.

      1. Biostatistician

      2. Project Manager

      3. Data Coordinator


  1. I get timely communications involving study issues.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


    • If your answer is “strongly disagree” or “disagree,” select all staff who were not accessible.

      1. Biostatistician

      2. Project Manager

      3. Data Coordinator


  1. The CSPCC provides accessible and relevant information about the study and procedures that affect my role.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree

Part 3 – Courtesy, Knowledge, and Professionalism


  1. I am satisfied with the courtesy of the CSPCC staff.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. I am satisfied with the knowledge of CSPCC staff.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. I am satisfied with the professionalism of the CSPCC staff.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. The CSPCC listens to and considers my opinions in decision-making issues related to study changes.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. The CSPCC includes me in study meetings and conference calls.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  1. I am satisfied with the roles and responsibilities given to me by CSPCC.

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


Part 4 – Willingness to Recommend Working with Future CSP Studies


  1. If asked by a colleague, how willing would you be to recommend this CSPCC to work with you on your future CSPCC research?

    1. Strongly disagree

    2. Disagree

    3. Neither agree or disagree

    4. Agree

    5. Strongly agree


  • Do you have any needs that we are currently not addressing?


  • Do you have any comments, complaints, or concerns about the support from this Center?


  • Do you have any compliments or recognitions involving particular people from this Center?


  • You may include your name on this survey. (Optional)


  • If you would like to speak to someone about this Survey or the Service you received, please contact the Center Quality Manager.

    • Boston; Eric Rockefeller, (857) 364-2432

    • Hines; James Steward, (708) 202-5835

    • Palo Alto; Alaina Difuntorum, (650) 493-5000 X25896

    • Perry Point; Karen Brown, (410) 642-2411 X6267

    • West Haven; Kim DiBenedetto-Rogers, (203) 932-5711 X3795




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
Authormercincavage_l
File Modified0000-00-00
File Created2021-01-27
© 2024 OMB.report | Privacy Policy