Form 1 DGMO Customer Service Survey Questions

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

DGMO Customer Service Survey Questions

DGMO Customer Service Satisfaction Survey

OMB: 0915-0212

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DGMO CUSTOMER SERVICE SATISFACTION SURVEY



  1. Please select the area in which you work.

[HRSA Office of Federal Assistance Management (OFAM); HRSA Program Office; Other HRSA Office; Grant Recipient; Other External Entity]


  1. Please provide the grant number associated with your inquiry.

[Type grant number]



  1. What was the primary reason for your contact/communication with the HRSA Division of Grants Management Operations (DGMO)?

[Notice of Funding Opportunity (NOFO)/Grant Application; Notice of Award (NoA); FFR; Prior Approval; Grant Term and/or Condition; Closeout; Other]



  1. Which DGMO staff member assisted you?

[Type name]



Considering your most recent interaction with a DGMO staff member, please indicate the degree to which you agree or disagree with the following statements:

  1. I am satisfied with the service I received from the DGMO employee.

[Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree]

  1. This interaction increased my confidence in the DGMO employee.

[Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree]


  1. My need was addressed by the DGMO employee.

[Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree]


  1. It was easy to complete what I needed to do with assistance from the DGMO employee.

[Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree]


  1. It took a reasonable amount of time to do what I needed to do.

[Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree]


  1. I was treated fairly by the DGMO employee.

[Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree]


  1. The DGMO employee I interacted with was helpful.

[Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree]







  1. How long did it take for you to receive a response to your specific question, concern or request?

[1-2 business days; 3-4 business days; 5 or more business days; I did not receive a response]


  1. How would you rate your overall customer service experience?

[Excellent; Good; Fair; Poor]


  1. Do you have any other comments, questions, concerns?

[Type comments]



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorTaylor, Erika (HRSA)
File Modified0000-00-00
File Created2021-01-15

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