D Attachment D - Annual Satisfaction Survey

OMB Control Number: 0915-0212

Expiration Date: 05/31/2018

Annual Awardee Satisfaction Survey

Landing Page

The HV-ImpACT is conducting a satisfaction survey to gather information about your experiences with the technical assistance received over the past 12 months. The HV-ImpACT will not penalize or reward you based on your responses to this survey. It will take you approximately 13 minutes to complete the survey.

The information you provide will help the HV-ImpACT make improvements to future technical assistance activities. Your responses to the survey are strictly confidential. Your individual responses will not be reported.

Completing the survey is voluntary. If you have questions about this project, you may contact [name] at [email]. We sincerely appreciate your time and willingness to participate.

By clicking “I agree” below you are indicating that you have read and understood this consent form and agree to participate in this survey. You may print a copy of this page for your records.

• I agree

• I do not agree (If selected, skip to thank you page)

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 0915-0212. Public reporting burden for this collection of information is estimated to average 0.22 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, MD, 20857.

Section 1: Background

1. Listed below are the HV-ImpACT’s universal technical assistance activities and resources that were provided this previous year. Please select all of the activities and resources you used. (Check all that apply.)

1. Monthly webinars

2. Grantee Model Developer Webinar Dialogues

3. Community of Practice

4. Home Visiting Issues and Insights (issue brief)

5. Home Visiting Home Run newsletter

6. MIECHV Groupsite

7. None of the above (If checked, skip Section 2)

2. Did you receive targeted technical assistance from your TA Specialist in the past year?

1. Yes

2. No (If checked, skip Section 3)

3. I don’t know (If checked, skip Section 3)

Section 2: Universal

1. Please consider the following activities and resources when answering the questions below: monthly webinars, Grantee Model Developer Webinar Dialogues, Community of Practice, Home Visiting Issues and Insights, Home Visiting Home Run newsletter, and MIECHV Groupsite.

(Matrix) Please indicate the extent to which you agree or disagree with the following statements.
The information provided was relevant to an issue our organization is facing.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
We applied the information that we learned in our work.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
We shared what we learned with others in our organization.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree

(Matrix) Overall, how satisfied are you with the quality of the following items?
Monthly webinars
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
Grantee Model Developer Webinar Dialogues
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
Communities of Practice
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
Home Visiting Issues and Insights
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
Home Visiting Home Run newsletter
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
MIECHV Groupsite
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied

(Matrix) As a result of the technical assistance received
Our organization is better able to meet its goals.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
Our organization is better prepared to provide services to our LIAs.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
Our organization has taken at least one action step towards improving our program.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree

Section 3: Targeted Technical Assistance

1. When answering the questions below, please consider the targeted technical assistance your organization received. This includes any technical assistance you received from your TA Specialist via a phone call, an email, or an in-person visit.

(Matrix) Please indicate the extent to which you agree or disagree with the following statements
The information provided was relevant to an issue our organization is facing.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
We applied the information that we learned in our work.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
We shared what we learned with others in our organization.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree

(Multiple choice) Overall, how satisfied are you with the quality of the targeted technical assistance?
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied

(Matrix) As a result of the targeted technical assistance received
Our organization is better able to meet its goals.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
Our organization is better prepared to provide services to our LIAs.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
Our organization has taken at least one action step.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree

2. (Open-ended) In the last year, has there been an engagement with your TA Specialist in which you were not satisfied with your experience? If yes, please explain.

Section 4: Overall/Conclusion (all grantees who participated in any technical assistance)

(Matrix) In thinking about the past year, please rate your overall satisfaction with the following:
The responsiveness of the HV-ImpACT to the needs of your organization
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
The quality of the technical assistance offered by the HV-ImpACT
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
The value of the technical assistance offered by the HV-ImpACT
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
The timeliness of the technical assistance offered by the HV-ImpACT
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied

(Matrix) Please indicate the extent to which you agree or disagree with the following statements
The technical assistance offered by the HV-ImpACT improved our ability to reach our performance measures.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
The technical assistance offered by the HV-ImpACT increased our capacity to engage families.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
The technical assistance offered by the HV-ImpACT increased the knowledge and skills of our workforce.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree

3. (Open-ended) In what ways could the HV-ImpACT technical assistance better support you?

Thank you page

(After the end of the survey): Thank you for taking the time to provide feedback regarding the HV-ImpACT. Your responses will help the HV-ImpACT improve future technical assistance offerings.