Form SV-2012-0001 OFM Customer Satisfaction Survey

U.S. Department of State OMB No: 1405-0193

OFM Customer Service Survey Expiration Date: xx/xx/xxxx

Estimated Burden: 3 minutes

You recently visited OFM via e-Gov, walk-in or by phone and we want to be sure you are satisfied with the outcome. We have a brief questionnaire about your visit to find out about your level of satisfaction and what we might do to improve. Please help us by completing this short survey. Your feedback will be used to improve our service. Your responses will remain anonymous, unless otherwise indicated by you below.

Statement	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable (N/A)
The customer service representative was courteous and professional.	1	2	3	4	5	N/A

Question	Less Than 1 Hour	1 Day	2 Days	3-5 Days	Greater Than 5 Days	Not Resolved
How long did it take to satisfy the request or resolve the issue reported?	1	2	3	4	5	N/R

Statement	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable (N/A)
I am satisfied with the time it took to resolve the request/issue reported.	1	2	3	4	5	N/A
I am satisfied with the representative's understanding of the issue I reported.	1	2	3	4	5	N/A
I am satisfied with the overall service I received.	1	2	3	4	5	N/A

Please note whether you may be Contacted.				Your contact information (optional)
Would you like to be contacted regarding the service you received?	Yes	No		Name: Email Address: Phone Number:
May we contact you regarding the service you received?	Yes	No

Comments or Suggestions.

Please tell us one thing OFM could do to improve our service or provide any other comment you would like to share with us.

Thank you for taking this survey!

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: [email protected]

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: [email protected]

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: [email protected]

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: [email protected]

SV2012-0001

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: DS/OFM, 3507 International Place NW, Washington, DC 20008.