Form 6200-11 What Do You Think About the U.S. EPA's Community Involve

Consolidated Superfund Information Collection Request (Renewal)

1487.13 Form 6200-11

NCP - Individuals (Community Members)

OMB: 2050-0179

Document [docx]
Download: docx | pdf

OMB Control Number: 2050-0179

Expiration Date: XX/XX/2019

EPA Form Number: 6200-11


What Do You Think About the U.S. EPA’s Community

Involvement Efforts at the ________ Site?


Purpose for this Questionnaire: This customer satisfaction survey is meant to help understand how well EPA staff are listening to community member concerns about the cleanup and how well EPA staff make it possible for community members to participate in the planning and decision making process.

Instructions: You may be asked some or all of the questions on this questionnaire. This questionnaire should take no more than 15 minutes to complete.


Burden Statement: The public reporting and recordkeeping burden for this collection of information is estimated to average 15 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed survey to this address.


The U.S. Environmental Protection Agency (U.S. EPA) is cleaning up the contamination at the __________ Superfund site in your community. The U.S. EPA believes the active, meaningful involvement of community members is critical to the success of a cleanup effort. This survey is an opportunity for you to tell us how well we are doing at listening to your concerns about the cleanup and making it possible for you to participate in the planning and decision making process. Please take a few minutes to answer the questions. Your views are important and will help us to be more responsive to your needs and interests.


This survey is being conducted in accordance with the Federal Paperwork Reduction Act Information Collection Request # 1487.13. You will need about 15 minutes to answer the questions.


*Note to surveyors: It is intended that each survey given will include the introductory paragraph, above, and Section G with the closing disclosure. Sections A-F are optional sections with questions that may be used as a specific situation dictates. This survey is NOT intended to be given in its entirety. The surveyor may also choose, in addition to paper copies, to provide the survey to participants online via commercially available software.












Section A: Assessing Overall U.S. EPA Community Involvement Efforts


A-1. How do you rate the U.S. EPA at each of the following? (Circle one choice for each question)


  1. Providing the information you need.

Very Poor

Poor

Average

Good

Very Good

  1. Making the information easy to understand.

Very Poor

Poor

Average

Good

Very Good

  1. Making it easy to get involved.

Very Poor

Poor

Average

Good

Very Good

  1. Listening to your concerns.

Very Poor

Poor

Average

Good

Very Good

  1. Responding to your concerns.

Very Poor

Poor

Average

Good

Very Good

  1. Treating you courteously.

Very Poor

Poor

Average

Good

Very Good

  1. Using your input.

Very Poor

Poor

Average

Good

Very Good

  1. Explaining decisions.

Very Poor

Poor

Average

Good

Very Good


Section B: Assessing U.S. EPA Efforts at Keeping Communities Informed


B-1. How do you learn about the U.S. EPA’s work at the site? (Check all that apply)


_____

U.S. EPA mailings

_____

Newspaper articles

_____

Radio or TV news

_____

U.S. EPA’s web page

_____

Community members/family/friends

_____

Public meeting or information session held by the U.S. EPA

_____

Direct conversation with someone from the U.S. EPA

_____

Information about the site is “common knowledge”

_____

Know someone who worked at the site

_____

Through one or more community organizations, business associations, or advisory groups (CAG)

_____

Social Media (Facebook, Twitter, etc.)

_____

Other (Please specify): ____________________________________________________________



B-2. How would you prefer to receive information from the U.S. EPA about the site?

(Check up to 3 choices)


_____

Mailings—short (1-2 pages) very focused (issue-specific) sent frequently

_____

Mailings—longer, general information, sent periodically

_____

Emails—brief, very focused (issue-specific) sent frequently

_____

Emails—longer, general information, sent periodically

_____

Meetings—short, very focused, held frequently

_____

Meetings—longer, general informational meetings, held periodically

_____

Social media (Facebook, Twitter)

_____

Direct communication with an U.S. EPA representative

_____

The U.S. EPA website

_____

Presentations at local clubs and organizations

_____

Other (Please specify): ____________________________________________________________

B-3. How interested are you in obtaining information about the following topics? (Circle one answer for each question)


  1. U.S. EPA’s Superfund Program.

Not Interested

Somewhat Interested

Interested

Very Interested

  1. Contamination at the site.

Not Interested

Somewhat Interested

Interested

Very Interested

  1. How the site might affect human health.

Not Interested

Somewhat Interested

Interested

Very Interested

  1. How the site might affect the environment.

Not Interested

Somewhat Interested

Interested

Very Interested

  1. Site cleanup decisions.

Not Interested

Somewhat Interested

Interested

Very Interested

  1. Site reuse or redevelopment.

Not Interested

Somewhat Interested

Interested

Very Interested

  1. Other (Please specify):_____________

Not Interested

Somewhat Interested

Interested

Very Interested


B-4. In what ways do you prefer to participate at this site? (Check all that apply)


_____

Through opportunities to provide written comments on U.S. EPA documents.

_____

Through public meetings.

_____

Through opportunities to meet and talk informally with U.S. EPA staff.

_____

By attending community club/organization meetings that U.S. EPA staff have been invited to.

_____

By calling a toll-free telephone number.

_____

Through a community group.

_____

Through opportunities to talk with independent experts.

_____

Through a web site or social media.

_____

Other (Please specify): ___________________________________________________________

_____

Not interested in being involved.


B-5. Please tell us whether you have ever:

  1. Provided information to the U.S. EPA about the site and its history.

Yes

No

  1. Expressed your concerns about the site to the U.S. EPA.

Yes

No

  1. Offered suggestions or advice about the site to the U.S. EPA.

Yes

No

  1. Given comments to the U.S. EPA on materials available for public review.

Yes

No

  1. Requested information from the U.S. EPA about the site.

Yes

No

  1. Attended a U.S. EPA-sponsored meeting or event about the site.

Yes

No

  1. Visited the site’s information repository.

Yes

No







B-6. In a few words, what is your understanding of the cleanup work U.S. EPA plans to do at the site?


___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

B-7. How concerned are you that the site may be harmful to each of the following: (Circle one answer for each question.)


  1. My or my family’s health.

Not

Concerned

Somewhat

Concerned

Concerned

Very

Concerned

Not Applicable

  1. The environment.

Not

Concerned

Somewhat

Concerned

Concerned

Very

Concerned

Not Applicable

  1. Property values.

Not

Concerned

Somewhat

Concerned

Concerned

Very

Concerned

Not Applicable

  1. Jobs in the community.

Not

Concerned

Somewhat

Concerned

Concerned

Very

Concerned

Not Applicable

  1. Business in the community.

Not

Concerned

Somewhat

Concerned

Concerned

Very

Concerned

Not Applicable

  1. Community historical or cultural integrity.

Not

Concerned

Somewhat

Concerned

Concerned

Very

Concerned

Not Applicable

  1. Site redevelopment or reuse.

Not

Concerned

Somewhat

Concerned

Concerned

Very

Concerned

Not Applicable






















Section C: Public Meeting Feedback Questions


These questions will help the U.S. EPA better understand what worked well and what improvements to consider making before holding future public meetings.


C-1. How did you learn about this public meeting? (Check all that apply)


_____

U.S. EPA mailings (other than this survey)

_____

Newspaper articles

_____

Radio or TV news

_____

Community organization

_____

Family or friends

_____

Email from U.S. EPA

_____

U.S. EPA’s website

_____

Social media (Facebook, Twitter, etc.)

_____

Flyers in store windows/bulletin boards

_____

Direct conversation with someone from the U.S. EPA

_____

Other (Please specify): ___________________________________________________________


C-2. Please give us your feedback on the following: (Circle one choice for each question)


a. Information about the meeting was available early enough to make plans to attend.

Strongly Disagree

Disagree

Agree

Strongly Agree

b. Meeting location was convenient.

Strongly Disagree

Disagree

Agree

Strongly Agree

c. Meeting facility was comfortable.

Strongly Disagree

Disagree

Agree

Strongly Agree

d. Meeting time was convenient.

Strongly Disagree

Disagree

Agree

Strongly Agree

e. The length of the meeting was appropriate.

Strongly Disagree

Disagree

Agree

Strongly Agree

f. Language interpreters were available

(if needed).

Strongly Disagree

Disagree

Agree

Strongly Agree

g. Provisions were made to accommodate the needs of persons with disabilities

Strongly Disagree

Disagree

Agree

Strongly Agree

  1. Meeting facility was well-equipped for all planned activities (enough seats, work space, supplies, etc.).

Strongly Disagree

Disagree

Agree

Strongly Agree



C-3. What topics were of most interest to you at the meeting?

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________


C-4. How was the meeting useful to you? ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________


C-5. How can U.S. EPA improve the next public meeting?

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________


Section D: Questions for Use During Site Cleanup-Removal/Relocation


These questions will help the U.S. EPA better understand what worked well and what improvements to consider when implementing future removals requiring temporary relocation of residents.


Introduction: You were recently relocated while removal and restoration activities were completed at your property. These activities were designed to remove significant potential sources of _[contaminant]_ from your property, thereby reducing any potential _[contaminant]_-related health exposures. We would appreciate it if you could take a few moments to provide feedback on your relocation experience and the removal/restoration work that was completed on your property.


D-1. Relocation (Circle one choice for each question)


a. U.S. EPA staff were friendly and helpful.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

b. The relocation handouts I was given were useful and understandable.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

c. U.S. EPA staff responded to my questions in a timely manner.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

d. I was treated with courtesy and respect by U.S. EPA staff.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

e. U.S. EPA staff contacted me as often as I would have liked:






  • Before my relocation.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

  • While I was relocated.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

  • After my property was cleaned up and I was back in my home.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

f. I was well-informed of my choices for relocation (hotel, friend’s home, etc.).

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

g. I was well-informed about the expected length of my relocation and was kept informed of any changes.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

h. I was told when I needed to relocate with enough time to plan my move.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

i. The reimbursement paperwork was understandable.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

j. I received my reimbursement within 30 days.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

D-2. U.S. EPA’s Work on My Property: Removal and Restoration (Circle one choice for each question)


a. I was well-informed about the extent of the work U.S. EPA would do on my property.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

b. The specifics of the property restoration were explained in writing and provided to me.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

c. I was informed of the landscape options for my property.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

d. I understood what I had to do following the removal at my property in order for the landscaping to be successful.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

e. The on-site workers were courteous and respectful.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

f. I was kept informed about any changes in the schedule for the work on my property.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

g. I was informed if any of my possessions could NOT be decontaminated.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

h. My property was restored to a condition at least equal to its previous condition (recognizing that it may take time and water/aerating on my part for the seed to take or plants to grow).

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable

i. The work done on my property met my expectations.

Strongly Disagree

Disagree

Agree

Strongly

Agree

Not Applicable


D-3. Do you have any additional comments/feedback regarding your relocation or the removal/restoration work on your property? (Use the space below)


___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________


Section E: Questions for Use at Sites with Institutional Controls


These questions will help the U.S. EPA better understand whether community members are aware of, or interested in, information about any institutional controls (ICs) at the site­, which are administrative and legal controls, including limitations on land use or resource use, deed restrictions, or building codes. An example of an IC might be building code restrictions to prevent vapor intrusion, or preventing development on a landfill cap to avoid damage to the integrity of the cap surface. Community input can be essential to selecting, using, and monitoring ICs that are the best fit for the community and the protectiveness of the remedy.


E-1. Are you aware of any restrictions (institutional controls) in place at the site including limitations on land and/or resource use, building code requirements or deed restrictions?

___Yes ___ No


E-2. Would you like more information about restrictions (institutional controls) on the use of land or resources or any deed restrictions in place at the site?

___Yes ___ No


If yes, please contact (Name and phone number) to request the information.

















Section F: Questions about Technical Assistance Resources Provided to the Community


These questions will help the U.S. EPA better understand how to provide the most effective technical assistance resources at sites.


F-1. Do you know of any assistance U.S. EPA has provided to help you and other community members/groups better understand technical and scientific information regarding the site cleanup?


____Yes _____No (Please skip to question F-3)


F-2. How was technical assistance provided to your community? (check all that apply)

____

Through a Technical Assistance Grant (TAG)

____

Through Technical Assistance Services for Communities (TASC)

____

Through U.S. EPA site staff

____

Through assistance from a local, regional or national organization/entity/university

____

Through a Pediatric Environmental Health Specialty Unit (PEHSU)

____

Through a Technical Assistance Plan (TAP)

____

Through Technical Assistance for Public Participation (TAPP)

____

I do not know how the assistance was provided

____

Other (Please specify):__________________________________________________________
















Please rate how useful each of the following has been in helping community members better understand information about the site and take a more active role in the process:


a. Community informational newsletters and/or factsheets.

Not Helpful

Somewhat Helpful

Helpful

Very Helpful

Not Applicable

b. Presentations by experts to explain technical site information to the community.

Not Helpful

Somewhat Helpful

Helpful

Very Helpful

Not Applicable

c. Community informational workshops/trainings.

Not Helpful

Somewhat Helpful

Helpful

Very Helpful

Not Applicable

d. Redevelopment planning.

Not Helpful

Somewhat Helpful

Helpful

Very Helpful

Not Applicable

e. U.S. EPA provides facilitator or mediator to help the community.

Not Helpful

Somewhat Helpful

Helpful

Very Helpful

Not Applicable

f. U.S. EPA assists community groups that want to help the community understand or participate in the site cleanup process.

Not Helpful

Somewhat Helpful

Helpful

Very Helpful

Not Applicable

g. Other (Please specify): ___________________________

Not Helpful

Somewhat Helpful

Helpful

Very Helpful

Not Applicable




F-3. If technical assistance has not been provided to your community, which of the following activities could help you and other community members/groups better understand technical and scientific information regarding the site cleanup? (Check all that apply)


____

Community informational newsletters and/or factsheets.

____

Presentations by experts to explain technical site information to the community.

____

Community informational workshops/trainings.

____

Redevelopment planning.

____

U.S. EPA provided facilitator or mediator to help the community.

____

U.S. EPA gave assistance to one or more community groups that wanted to help the community understand or participate more actively in the site cleanup process.

____

Other (Please specify):__________________________________________________________

____

I don’t feel that any technical assistance is needed.




Section G: General Information [REQUIRED Section]


This section must be included at the end of all surveys.


G-1. Is there anything else you would like to tell us about the U. S. EPA’s community involvement efforts or about the cleanup activities at this site?


__________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________




Thank you for taking the time to share your views with us. If you would like to be on the U.S. EPA’s mailing list, please contact (Name, Telephone Number).








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