Form FEMA Form 519-01T FEMA Form 519-01T Public Assistance Customer Satisfaction Survey (Telephon

OMB Control No. 1660-0107
Expires August 31, 2015

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
PUBLIC ASSISTANCE CUSTOMER SATISFACTION SURVEY
PAPERWORK BURDEN DISCLOSURE NOTICE: Public reporting burden for this survey is
estimated to average 15 minutes per response. The burden estimate includes the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and submitting this survey. You are not required to respond to this
collection of information unless it displays a valid OMB control number. This collection of
information is voluntary. Send comments regarding the accuracy of the burden estimate and
any suggestions for reducing the burden to: Information Collections Management, Department
of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW,
Washington, DC 20472, Paperwork Reduction Project (1660-0107). Note: Do not send your
completed form to this address.
PRIVACY ACT STATEMENT

AUTHORITY: Government Performance and Results Act (GPRA), 5 U.S.C. Ch. 3 as
amended and the GPRA of 2010 (P.L. 111-352); Executive Order (EO) 12862 “Setting
Customer Service Standards;” and its March 23, 1995 Memorandum addendum,
“Improving Customer Service;” Executive Order 13411 “Improving Assistance for
Disaster Victims;” Executive Order 13571 “Streamlining Service Delivery and Improving
Customer Service;” and its June 13, 2011 Memorandum “Implementing Executive Order
13571 on Streamlining Service Delivery and Improving Customer Service.”
PRINCIPAL PURPOSE(S): DHS/FEMA collects this information to measure Public
Assistance applicants’ customer satisfaction with FEMA services.
ROUTINE USE(S): This information is used for the principal purpose(s) noted above
and will not be shared outside of DHS/FEMA, except as allowed under DHS/FEMA-009
- Hazard Mitigation Assistance, Public Assistance, and Disaster Loan System of
Records (Date, FR reference), or as required by law.
DISCLOSURE: The disclosure of information on this form is strictly voluntary and will
assist FEMA in making improvements to its Public Assistance program; failure to
provide the information requested will not impact the provision of FEMA Public
Assistance to qualified entities.

FEMA Form 519-0-1 T (Telephone)

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Public Assistance Customer Satisfaction Survey

Hello, I’m calling from FEMA, the Federal Emergency Management Agency. My name is
__________. My ID is ____________. May I please speak with [Contact Name]?

If applicant is not available:

Mark Attempt

If applicant is available:
We would like to ask some questions about your experience with the FEMA Public Assistance
Program. We’re looking for ways to improve the quality of our service based on your opinions.
Would you volunteer to take 10-15 minutes to answer some questions?
If no:

I understand, Thank you for your time and have a nice day/evening.

If yes: Thank you. These questions comply with the Privacy Act of 1974 and been
approved by the Office of Management and Budget under number 1660-0107. Your
answers will not affect the outcome of your application for FEMA assistance. This call
may be monitored or recorded for quality assurance.

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Public Assistance Customer Satisfaction Survey
GENERAL INFORMATION & QUESTIONS
This call is related to the [Disaster Type], declared on [Declaration date], in [State] under
Disaster Number [DR No].
The next few questions ask for general information.
1. What is your organization type? (read options0
 State Grantee
 Tribal Grantee
 Subgrantee
If response = State Grantee go to 1a, If response = Subgrantee go to 1b else go to Q2.
1a. What is your position? (read options)
 State Director
 Governor’s Authorized Representative – GAR
 Alternate GAR
 Public Assistance Officer – PAO
 Deputy PAO
 Sate Coordinating Officer – SCO
 Assistance SCO
 Other
Skip to Q4
1b. What is your position? (read options)
 Local government
 State subgrantee
 Special district
 Private non-profit
 Indian tribe/tribal organization/native village
 Other
2. For what type(s) of project(s) did you apply? (read options)
 Not applicable, state grantee
 All large projects over [Amount]
 All small projects under [Amount]
 More large than small projects
 More small than large projects
 Equal number of large and small projects
If response = All large projects go to Q4 else go to Q3.
3. Applicants have the option of writing their own Project Worksheet(s) for small projects. For
the small projects for which you applied, did you chose to write your own Project Worksheets
(s): (read options)
 All of the time
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Most of the time
Half of the time
Some of the time
Never
Not applicable, did not apply for small projects

4. Overall, how satisfied are you with the Public Assistance PROGRAM? (read list)
 Very Satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very dissatisfied
If response = Slightly dissatisfied, Dissatisfied or Very dissatisfied go to Q4a else go
to Q5
4a. What specifically were you dissatisfied with? (Text Box)
5. Overall, how satisfied are you with the Public Assistance PROCESS? (read list)
 Very Satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very dissatisfied
If response = Slightly dissatisfied, Dissatisfied or Very dissatisfied go to Q5a else go
to Q6
5a. What specifically were you dissatisfied with? (Text Box)
INFORMATION
The next questions pertain to your initial contact with FEMA.
6. How satisfied were you with the PUBLISHED INFORMATION fema PROVIDED ON THE
Public Assistance Program for example documents on FEMA’s website, documents received at
the Kickoff Meeting, etc.? (read list)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very dissatisfied
7. How satisfied were you with staff’s communication of information? (read first 6)
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Very satisfied
Satisfied
Slightly satisfied
Slightly dissatisfied
Dissatisfied
Very dissatisfied
Never dealt with staff

8. How satisfied were you the information FEMA provided you concerning the availability of
Public Assistance mitigation funding? (read first 6)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very dissatisfied
 Did not receive any information on mitigation
PERSONAL INTERACTION AND CUSTOMER SERVICE
The next questions concern your interactions with staff.
9. The field staff understood the eligibility requirements (read first 5)
 All of the time
 Most of the time
 More than half of the time
 Some of the time
 Never
 Do not know
10. The field staff that conducted the site visit(s) were competent and understood the types of
damage they were assessing (read first 7)
 All of the time
 Most of the time
 More than half of the time
 Some of the time
 Never
 Not applicable – No site visit(s) necessary because always wrote own Project
Worksheet(s)
 Not applicable – Site visit(s) not yet conducted
 Do not know
11. The field staff that conducted the site visit(s) understood the local conditions that could
influence the rebuilding process. (read first 7)
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Strongly agree
Agree
Slightly agree
Slightly disagree
Disagree
Strongly disagree
Not applicable – No site visit(s) necessary because always wrote own Project
Worksheet(s)
Not applicable – Site visit(s) not yet conducted
Do not know

12. How reliable were the decisions and information you received from staff? (read first 6)
 Very reliable
 Reliable
 Slightly reliable
 Slightly unreliable
 Unreliable
 Very unreliable
 Do not know
13. Was staff turnover a problem?
 Yes
 No
 Do not know
14. Overall, how satisfied were you with the CUSTOMER SERVICES provided by staff? (read
list)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very dissatisfied
15. Overall, how satisfied were you with the responsiveness provided by staff? (read list)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very dissatisfied
PROJECT WORKSHEET PROCESS
The next questions relate to the Project Worksheet Process.
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16. Overall, how satisfied were you with the Project Worksheet process? (read list)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very dissatisfied
17. Did you receive Public Assistance mitigation funding?
 Yes, received funding
 No – applied for but did not receive funding
 Did not apply for funding
 Do not know
If response = yes go to Q17a else go to Q18
17a. How satisfied were you with the amount of Public Assistance mitigation funding you
received? (read first 5)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Very dissatisfied
 Do not know
18. If FEMA conducted a sit visit, FEMA conducted the Project Worksheet site visit(s)? (read
first 3)
 Too soon after the disaster
 At the right time
 Too late to be helpful
 Site visit(s) not yet conducted
 No site visit(s) necessary because always wrote own Project Worksheet(s)
 Do not know
19. If FEMA developed the scope(s) of work, how satisfied were you with their development?
(read first 6)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very dissatisfied
 Not applicable – always wrote own Project Worksheet(s)
 Do not know
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Public Assistance Customer Satisfaction Survey

20. If FEMA identified damage repair cost estimates, how satisfied were you with these
estimates? (read first 6)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very Dissatisfied
 Cost estimates not yet completed
 Not applicable – always wrote own Project Worksheet(s)
 Do not know
21. If you wrote your own Project Worksheet(s), how satisfied were you with completing your
Project Worksheet(s) in terms of its complexity, your time investied, and the availability of
necessary information?
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Not applicable – Did not write any Project Worksheet(s)
22. If you had any small projects, and you chose not to write your own Project Worksheet(s),
please briefly explain why you asked FEMA to write your Project Worksheet(s). (Text box)
PROGRAM RESULTS
The next questions pertain to the overall results of the Public Assistance Program.
23. How satisfied were you with FEMA’s timeliness
23a. Overall? (read list)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very Dissatisfied
23b. In relation to providing information? (read list)
 Very satisfied
 Satisfied
 Slightly satisfied
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Slightly dissatisfied
Dissatisfied
Very Dissatisfied

23c. In relation to making eligibility decisions? (read list)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very Dissatisfied
23d. In relation to providing funds? (read list)
 Very satisfied
 Satisfied
 Slightly satisfied
 Slightly dissatisfied
 Dissatisfied
 Very Dissatisfied
24. How reasonable were administrative requirements for the following:
24a. Overall program (read list)
 Very reasonable
 Reasonable
 Slightly reasonable
 Slightly unreasonable
 Unreasonable
 Very unreasonable
24b. Pre-disaster documentation (read list as needed)
 Very reasonable
 Reasonable
 Slightly reasonable
 Slightly unreasonable
 Unreasonable
 Very unreasonable
24c. Project Worksheet review (read list as needed)
 Very reasonable
 Reasonable
 Slightly reasonable
 Slightly unreasonable
 Unreasonable
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Public Assistance Customer Satisfaction Survey
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Very unreasonable

24d. Payment of claims (read list as needed)
 Very reasonable
 Reasonable
 Slightly reasonable
 Slightly unreasonable
 Unreasonable
 Very unreasonable
ALTERNATIVE PROCEDURES
The next questions are related to Public Assistance Alternative Procedures which you may have
elected to use for permanent work and debris removal projects.
25. Were you offered the opportunity to participate in the Alternative Procedures ?
 Yes
 No
 Don’t know / Don’t remember
If response = No or Don’t know/Don’t remember go to Q32, if response = Yes go
to 25a
25a. Did you decide to participate? Would you say: (read list)
 Yes
 Started to but then opted out
 No
 Don’t know / Don’t remember
(If response = Started to but then opted out or No go to Q25b, If response =
Yes go to Q26)
25b. What were your reasons for not participating in the Public Assistance Alternative
Procedures? (Text Box)
Thinking about the program elements that influenced your decision to participate, would you
say:
26a. The incentives were (read list)
 Very Important
 Important
 Not Very Important
 Not at all Important
26b. Was the flexibility of the program
 Very Important
 Important
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Not Very Important
Not at all Important

26c. What other factors influenced your decision to participate? (Text Box)

The next questions relate to the impact of the Alternative Procedures on your current
level of recovery.
27. How would you rate the Alternative Procedures on improving the speed of your recovery?
Would you say:
 Excellent
 Good
 Satisfactory
 Below Average
 Poor
 No Opinion
 Too early to determine
If response = Below Average or Poor go to Q27a else go to Q28
27a. What changes could FEMA make to this program to improve your speed of recovery?
(Text Box)
28. How effective have the Alternative Procedures been in improving your recovery?
 Excellent
 Good
 Satisfactory
 Below Average
 Poor
 No Opinion
 Too early to determine
If response = Below Average or Poor go to Q28a else go to Q29
28a. What changes could be made to improve the effectiveness?
(Text Box)
29. How satisfied are you with the estimates used for your pilot program projects?
 Very Satisfied
 Satisfied
 Slightly Satisfied
 Slightly Dissatisfied
 Dissatisfied
 Very Dissatisfied
 No Opinion
 Too early to determine

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Public Assistance Customer Satisfaction Survey
If response = Slightly Dissatisfied, Dissatisfied or Very Dissatisfied go to Q29a
else go to Q30
29a. What changes are needed to improve your satisfaction with the estimates?
(Text Box)

30. If the independent expert panel was used on your projects, how satisfied are you with the
panel process?
 Very Satisfied
 Satisfied
 Slightly Satisfied
 Slightly Dissatisfied
 Dissatisfied
 Very Dissatisfied
 No Opinion
 Too early to determine
 Did not use expert panel
If response = Slightly Dissatisfied, Dissatisfied or Very Dissatisfied go to Q30a
else go to Q31
30a. What changes are needed to improve the panel process?
(Text Box)

31. In the future, should you need to apply for a Public Assistance grant, how likely are you to
use the Alternative Procedures option?
 Definitely use
 Probably use
 Might or Might Not use
 Probably would Not use
 Definitely would Not use
 Don’t know/No Opinion
32. What additional recommendations do you have for improving the alternative procedures?
(Text Box)
Thinking about this disaster and Public Assistance overall.
33. Is there anything you would have liked FEMA to have done differently during this disaster
recovery? (Text Box)
34. Please provide any additional comments or suggestions regarding the Public Assistance
Program.
(Text Box0
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Public Assistance Customer Satisfaction Survey

Thank you very much for your time. Have a good day/evening.

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