Health Benefits Education Campaign Compliance Assistance Generic IC

OMB#1225-0088
Expiration Date: 10/31/2020

Comments/Suggestions

Health Benefits
Education Campaign
Compliance Assistance Seminar

Survey

8. What additional information would you want to receive?

Simple Instructions to Complete this Survey
Use a blue or black ink pen that will not soak
EXAMPLE
through the paper.
Place a X inside the appropriate box next to
RIGHT WAY WRONG WAY
each question.
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PLEASE COMPLETE AND RETURN THIS
FORM TO THE SESSION ORGANIZERS.

X

X

WHAT IS YOUR ROLE?
COMMENTS
9. What ONE thing could the Department of Labor do to improve the
seminar for someone like you?

1. Please indicate your role below:
Employer/Plan Sponsor/Human Resources Manager/In House Benefits
Manager
Service Provider (Examples: Third Party Administrator, Insurance Broker,
Agent)
State or Federal Representative
Other (please specify)

PLEASE RATE THE SEMINAR OVERALL:

PLEASE RETURN THE COMPLETED FORM TO THE SESSION ORGANIZERS.
Paperwork Reduction Act Notice

This survey has been approved under Office of Management and Budget (OMB) control number 1225-0088 (exp. 10/31/2020).
The Paperwork Reduction Act of 1995 provides that no person is required to respond to a Federal collection of information unless
it displays a valid OMB control number. Your response is voluntary, and we will use this information to evaluate and improve the
quality of our services. The Department estimates that it will take approximately 2.5 minutes (on average) for respondents to
complete the survey. Please send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the U.S. Department of Labor, Office of the Chief Information Officer, Attention:
Information Management Program, 200 Constitution Avenue, N.W., Room N-1301, Washington, DC 20210 or email dol_pra_
[email protected] and reference the OMB Control Number 1225-0088.

2. Please rate your overall satisfaction with the
seminar:
3. Please rate the overall usefulness of the
information you received at the seminar:
4. Please rate the overall performance of the
presenters:

Very
Helpful

5
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4
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3
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2
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Not at all
Helpful

1
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Don’t
Know

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5. Please rate how much you agree or disagree with the following statements as they
pertain to the Health Benefits Education Campaign Compliance Assistance seminar.
(Mark ONE response for EACH statement)
Strongly
Agree

a. The information I received was clear and
easy to understand

5
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4
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3
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2
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Not at all
Satisfied

1
∇

Don’t
Know

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b. Federal Health Benefits Laws: Health Coverage Updates
Very
Helpful

Not at all
Helpful

5 4 3 2
∇∇∇∇

1
∇

Don’t
Know

∇

Too
Long

∇

Just
Enough

∇

Too
Short

∇

Don’t
Know

∇

Does Not
Apply

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Comments/Suggestions

b. The information I received increased
my understanding of the health benefits
regulations and issues
c. The presenters were well informed and
knowledgeable

c. State Insurance Department Update
Very
Helpful

d. The presenters gave the right level of
detail

Not at all
Helpful

5 4 3 2
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e. The presentations answered all of my
questions

1
∇

Don’t
Know

∇

Too
Long

∇

Just
Enough

Too
Short

Don’t
Know

Does Not
Apply

Just
Enough

Too
Short

Don’t
Know

Does Not
Apply

Just
Enough

Too
Short

Don’t
Know

Does Not
Apply

∇

∇

∇

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Comments/Suggestions

6. How did you hear about the seminar?

d. COBRA Continuation Coverage
7. Please rate the helpfulness of each of the seminar sessions/discussions and whether
you felt the session was too long, too short, or just long enough. You may wish to
write comments or suggestions in the space provided.
Mark ONE response for each helpfulness and length of the session Mark “Does Not
Apply” if you did not attend the session or the session was not offered.

Very
Helpful

Not at all
Helpful

5 4 3 2
∇∇∇∇

1
∇

Don’t
Know

∇

Too
Long

∇

∇

∇

∇

∇

Comments/Suggestions

a. What it Means to be a Group Health Plan Fiduciary
Very
Helpful

Not at all
Helpful

5 4 3 2
∇∇∇∇

1
∇

Comments/Suggestions

Don’t
Know

∇

Too
Long

∇

Just
Enough

∇

Too
Short

∇

Don’t
Know

∇

Does Not
Apply

∇

e. Family and Medical Leave Act
Very
Helpful

Not at all
Helpful

5 4 3 2
∇∇∇∇

1
∇

Don’t
Know

Comments/Suggestions

∇

Too
Long

∇

∇

∇

∇

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