Form SV02015-0005 ACS Applicant Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

ACS Applicant Satisfaction Survey (4-2015)

ACS Applicant Satisfaction Survey

OMB: 1405-0193

Document [docx]
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U.S. DEPARTMENT OF STATE
AMERICAN CITIZEN SERVICES APPLICANT
SATISFACTION SURVEY



OMB No: 1405-0193

Expiration Date: 07/31/2017

Estimated Burden: 3 minutes
SV-2015-0005

We ask that you take a brief survey to assess your experience with the United States consular section at the U.S. [Embassy/Consulate General name]. Your responses will be kept private and not associated with you or your case. We are only conducting this survey to improve our service.



  1. U.S. Embassy/Consulate General _[Dropdown option choices for electronic survey or write-in option for paper]_


  2. Indicate service received:

  • U.S. Passport

  • Consular Report of Birth Abroad

  • Notary Services

  • Other ____________________________


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If used,
was source helpful?


PREPARING FOR YOUR APPOINTMENT

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  1. 3. How did you obtain information to prepare for your appointment? Check all that apply.






Yes

No

  • Family member or friend

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  • Attorney/Notary

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  • Consultant

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  • U.S. Department of State website (travel.state.gov)

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  • [Embassy/Consulate General name] website in English

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  • [Embassy/Consulate General name] website in [country’s official language]

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  • [Embassy/Consulate General name] phone or email in English

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  • [Embassy/Consulate General name] phone or email in [country’s official language]



  • [Embassy/Consulate General name] social media (e.g., Facebook, Twitter)

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  • Other ____________________________

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  1. Did you need help in completing the forms?

  • No

  • Yes, by a family member or friend

  • Yes, by an attorney/notary

  • Yes, by contacting the [Embassy/Consulate General name] by phone or email in English

  • Yes, by contacting the [Embassy/Consulate General name] by phone or email in [country’s official language]

  • Yes, other ____________________________

  • No forms were required for the service I received.



  1. If you used the [Embassy/Consulate General name] website, were instructions and requirements clear (i.e., documents needed for appointment, items allowed inside the [Embassy/Consulate General])?

  • Yes

  • No

  • I did not use the [Embassy/Consulate General name] website


  1. Prior to your appointment, which of the following would you have liked to receive additional information about?

  • What to expect at the appointment (i.e., the security process, waiting room experience, parking, appointment time and duration)

  • Prohibited items that are not allowed in the [Embassy/Consulate General name]

  • Supporting documentation required (e.g., proof of identity, birth certificate)

  • Information on how to change appointment time

  • Document delivery service

  • Other ______________________________________



APPOINTMENT SCHEDULING

  1. Was it convenient to make an appointment for the date and time you wanted?

  • Yes

  • No, I needed an earlier appointment date, and one was not available.

  • No, other: _______________________________________________



  1. If it was difficult for you to schedule or reschedule your appointment, please indicate why. Check all that apply.

  • The scheduling or rescheduling process was confusing.

  • I do not have access to or use the internet.

  • I had to call the [Embassy/Consulate General].

  • Other_________________________________________



DURING THE APPOINTMENT

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  1. 9. Please rate your visit to [Embassy/Consulate General name].



Excellent

Satisfactory

Needs Improvement

Courtesy of the security guards

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Courtesy of the consular staff

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Answers to your questions

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Explanation regarding your case

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Cleanliness and comfort of the waiting area

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Duration of wait time

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  1. Please use the space below for any additional suggestions on what we could improve.

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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: Department of State, Bureau of Consular Affairs, ATTN: Catherine Barry, 600 19th Street, N.W., Washington, DC 20036.

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