TA Customer Satisf TA Customer Satisfaction Feedback Form

Attachment 6: TA Customer Satisfaction Protocol and Instrument

OMB No. 0930-0197

Expiration Date: 1/31/2017

Public Burden Statement: An agency 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.  The OMB control number for this project is 0930-0197.  Public reporting burden for this collection of information is estimated to average 5 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, 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 this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland, 20857.

Technical Assistance Tracker (TA Tracker)

The NRC uses the TA Tracker data system to monitor the activities, including TA of SS/HS, Project LAUNCH, and the field.

TA Satisfaction Data Collection Process. The NRC will use the appropriate indicator from the TA Tracker to select completed/closed TA requests during the months of October, January, April, and July. The people who requested TA during these months will receive an online TA Satisfaction Survey. The survey will be administered in October, January, April, and July. Effort will be made to not survey the same person more than one time per quarter. If a person receives more than one completed TA service during that month-long assessment period, they would be asked to refer to their most recently completed TA service during that period. Email messages with links to the online questionnaire will be sent to persons whose TA requests have been completed or closed during the survey period (e.g., TA that involves RSs providing information, advice, or other guidance directed at solving a problem facing the grantee or addressing a capacity need). Specific request exclusion criteria will be developed with the NRC.

Once a TA request has been closed (during the selected survey period), an email message with a link to the electronic survey (see examples for SS/HS, Project LAUNCH, and field-level recipients below) is sent to the grantee or field representative that received assistance, based on their contact information provided on the TA Tracker or contact information provided by the RS. Two follow-up messages will be sent during the two-week survey administration period. Given that TA requesters represent a range of state, local, tribal, or territorial staff, accommodations (i.e., hard-copy distribution of the survey, translated materials) may be needed. After data collection ends, the specific NRC staff generate a database of survey responses and conducts data cleaning, analyzes the data quarterly and annually, and reports the findings to NRC staff as part of the continuous quality improvement process and the annual performance assessment.

Technical Assistance Customer Satisfaction Feedback Form Invitation Email

Dear [insert name]:
 
On behalf of the Assessment Team at Community Science, I am writing you about the National Resource Center for Mental Health Promotion and Youth Violence Prevention (NRC). We hope that you will assist us in making sure the NRC provides the best possible technical assistance to you and other [insert grant program name OR indicate it is fieldwide] grantees by participating in our brief, three-minute survey [insert hyperlink here].

You are receiving this email because you recently requested and received technical assistance from the NRC. The survey asks several important questions about your recent experience receiving technical assistance services from the NRC. To start the survey, click on this link [insert NRC Customer Satisfaction Feedback Form hyperlink here].

Your participation is voluntary. To ensure confidentiality, no individual identifying information will be associated with your responses to these questions. Please complete and submit your responses by [insert month, date, year]. [Insert NRC Customer Satisfaction Feedback Form hyperlink here]

Thank you!
 
[NRC project director or GPO signature]

Technical Assistance Customer Satisfaction Feedback Form

We are requesting that you answer a few important questions designed to collect information about your recent experience receiving technical assistance from the NRC. Your feedback will help ensure that the NRC is fully meeting the technical assistance and training needs of all the people it serves.

The survey will take about five minutes or less to complete. Your participation is completely voluntary, and you can decline to participate. You can also stop your participation at any time by choosing not to submit your responses. In order to ensure confidentiality, no individual identifying information will be associated with your responses to these questions. Your responses may be included with those of other respondents in aggregate form in reports or journal articles. Identifying information will be separated from survey responses and stored separately in a password-protected database.

If you have any questions regarding this survey, please contact [TBD].

The following statements refer to the NRC technical assistance service(s) provided to you and completed during this past month of [month to be entered].

Please read the statements below and rate the extent to which you disagree or agree with each regarding the recent technical assistance from the NRC you recently received by selecting the number that matches your opinion.

	Strongly Disagree	Disagree	Agree	Strongly Agree	Not Applicable
Overall, I am satisfied with how the NRC technical assistance service was provided.	1	2	3	4	n/a
My organization or grant program needs were met.	1	2	3	4	n/a
The NRC technical assistance service was provided and completed in a timely manner.	1	2	3	4	n/a
The technical assistance provider understood the culture, language (e.g., Spanish), and age group of the population we serve.	1	2	3	4	n/a
The NRC technical assistance I received took into account the political, economic, and historic conditions in which the grant program or organization is operating.	1	2	3	4	n/a
My organization will definitely apply the information that was provided through the NRC technical assistance I received.	1	2	3	4	n/a

Please tell us how the NRC technical assistance can be improved.

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Is there anything else you would like to share with us about your experience receiving technical assistance from the NRC?

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Would you like someone to follow up with you about your request? ☐ Yes ☐ No

If yes, please provide your name and contact information so that an NRC staff member can reach you.

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Thank you for your participation!

Attachment 6 4