NRC Form 659 Public Meeting Feedback Form

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

NRC 659 public meeting feedback form

NRC Form 659, Public Meeting Feedback Form

OMB: 3150-0217

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NRC FORM 659
(MM-YYYY)

U.S. NUCLEAR REGULATORY COMMISSION

NRC PUBLIC MEETING
FEEDBACK

Meeting
Date:

EXPIRES: (MM/DD/YYYY)

APPROVED BY OMB: NO. 3150-0217

Estimated burden per response to comply with this voluntary information request: 15 minutes. The
information will be used to assess the effectiveness of NRC staff communications and outreach with
the public. Send comments regarding this estimate to the FOIA, Privacy, and Information Collections
Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to
[email protected] and to the Desk Officer, Office of Information and Regulatory Affairs,
NEOB-10202 (3150-0217), Office of Management and Budget, Washington, DC. If a means used to
impose an information collection does not display a currently valid OMB control number, the NRC may
not conduct or sponsor, and a person is not required to respond to, the information collection.

Meeting
Title:

Thank you for attending this public meeting hosted by the NRC. In order to help us understand your views about this
meeting and improve future meetings, please take a couple minutes to answer the questions below.
There are several ways you can provide your feedback:
1) Scanning the Quick Response (QR) Code on the back of this form with your smartphone to link directly to our
feedback page. If you do not have a QR reader on your mobile device, you can use your App store to access
available QR scanning applications suitable for your device.
2) Through any computer by going to the Public Meeting Schedule and pressing the “Meeting Feedback” link for the
specific meeting, or pressing the “[…more]” link for a specific meeting and then pressing the “Meeting Feedback”
link on the “Meeting Details” page.
3) By filling out this hard copy of our “Public Meeting Feedback Form” and providing it to an NRC staff member or
mailing it in.
Please fold on the dotted lines with Business Reply side out, tape the bottom, and mail back to the NRC.
Note: You have up to 30 days after the meeting has ended to submit feedback on the public meeting that you've
attended. Thank you again for your participation.

Please address the following statements in terms of your experience at the meeting. 1 is "strongly disagree" and 5 is
"strongly agree."
"STRONGLY
DISAGREE"

"DISAGREE"

"NEITHER
AGREE OR
DISAGREE"

"AGREE"

"STRONGLY
AGREE"

1. The meeting achieved its stated purpose.

1

2

3

4

5

2. This meeting helped me to understand the topics discussed.

1

2

3

4

5

3. The meeting location, format, starting time, and duration were
reasonably convenient.

1

2

3

4

5

4. The meeting facility, room set up, microphones, and visuals
used contributed to the success of the meeting.

1

2

3

4

5

5. Attendees, including those participating remotely, were given
sufficient opportunity to ask questions or express their views.

1

2

3

4

5

6. Attendees were listened to and understood by NRC staff.

1

2

3

4

5

7. The presentations and explanations given by the NRC staff
were understandable, fair and balanced.

1

2

3

4

5

8. I am satisfied overall with the NRC staff who participated
in the meeting.

1

2

3

4

5

OPTIONAL
Name
Telephone No.
NRC 659 (MM-YYYY)

Organization
E-Mail

Check here if you would like a
member of NRC staff to contact you.

Please provide any suggestions you have on ways the NRC could improve its public meetings:

QR CODE

UNITED STATES
NUCLEAR REGULATORY
COMMISSION
WASHINGTON DC 20555-0001

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

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FIRST CLASS MAIL

PERMIT NO. 12904

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POSTAGE WILL BE PAID BY U.S. NUCLEAR REGULATORY COMMISSION

ATTN:
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UNITED STATES NUCLEAR REGULATORY COMMISSION
WASHINGTON DC 20555-0001


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